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Arthrodiastasis in LCP Treatment: Case Studies and Discussions

This study delves into the effectiveness of arthrodiastasis in Legg-Calvé-Perthes disease treatment, focusing on joint ROM restoration, containment, and maintaining movement. Detailed case studies and discussions highlight positive outcomes and potential complications.

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Arthrodiastasis in LCP Treatment: Case Studies and Discussions

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  1. Arthrodiastasis in LCP Sung Soo Kim, M.D., Wook Kim, M.D. and Chan Woo Lee, M.D. Department of Orthopaedic Surgery, College of Medicine, Dong-A University, Busan, Korea

  2. Introduction • No treatment has been shown convincingly to be significantly effective in improving the outcome of LCP

  3. Introduction Treatment principle Restore Joint ROM Containment

  4. Introduction • Arthrodiastasis • Verona 1979 • Osteoarthritis • Chondrolysis • AVN

  5. Introduction • Creating a space • Minimizing mechanical stress • Maintaining movement • Synovial circulation restore • Preserve intact and congruent femoral head (Aldegheri et al Clin Orthop 1994)

  6. Case • F/6 • Left hip pain • Limping gait • ROM limitation : Abduction 30⁰, Internal rotation 10⁰ • Symptom duration : 2 months • Skin traction

  7. Case • Adductor tenotomy after I week skin traction • Patrie cast for 6 weeks

  8. Case • 6 months after Adductor tenotomy • Catterall group Ⅲ • Lateral Pillar group B • Internal rotation 10⁰ • Epiphyseal index 0.62 ( ratio of epiphysis height to width. Eitan et al 2004)

  9. Case • Arthrodiastasis with Orthrofix hinged external fixator • Range of motion : flexion 0⁰-90⁰

  10. Case • Postoperation 2 months external fixator removal

  11. Case • Postoperation 19 months • Recovery of full range of motion

  12. Case • Postoperation 6.5 years (13years old) • Epiphyseal index 0.92 • Lateral pillar group B • No pain • Full range of motion • Leg length discrepancy 1cm PO 4.5 years PO 5.5 years PO 6.5 years

  13. Discussion • Kocaoglu et al 1999 • 11patient mean age 7.5 years • 7 hip classified Herring grade B(4 cases), C(7 cases) • All hip Catterall classified group 3 or 4 • Fixation with ilizarov external fixator • Healing phase rapid progress • But containment was sustained in only 4 cases • Pin tract infection, pin loosening, joint stiffness • 2 cases flexion extension exercise

  14. Discussion • Brasil group 2000 • Prospective study 36 patients • 18 patients varus femoral osteotomy • 18 patients arthrodiastasis with external fixator • Indication include necrosis or fragmentation stage, • Catterall group 3 or 4 with at least 2 head-at-risk signs • Both group satisfactory result • Faster remodelling femoral head in arthrodiastasis group

  15. Discussion • Complication • Pin tract infection • Pin loosening • Stiffness • Correlated with duration of external fixator

  16. Discussion • True non-weight-bearing containment • Neovascularization in distracted tissue • Nutrition of chondral tissue • Remodelling of the femoral head

  17. Thanks for your attention

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