1 / 32

PELVIC OBLIQUITY

PELVIC OBLIQUITY. Mohahad osman, MD Assist. prof. Zagazig University. Definition of Pelvic Obliquity ( PO).

eldora
Download Presentation

PELVIC OBLIQUITY

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PELVIC OBLIQUITY Mohahad osman, MD Assist. prof. Zagazig University

  2. Definition of Pelvic Obliquity ( PO) A- PO is failure of the pelvis to lie in a perfectly horizontal position in the frontal plane; ie; interspinous line is not perpendicular to midline of body provided that legs are parallel to midline of body. B- 3-D definition : any fixed malalignment bet. Spine & pelvis, in frontal, sagittal, horizontal or all these 3 planes.

  3. CLASSIFICATIONS of PO. I- Mayer (1936) : 1- Functional / non-structural PO : - present only when pt. stands with knees straight & no lift under foot & disappear on sitting & on recumbency w legs parallel to midline of body - due to LLD. 2- Structural / fixed PO : -persists in all positions & cannot be passively corrected. -Aetiology: a- infrapelvic (hips) b- pelvic c-suprapelvic ( spine) d- combined

  4. Classifications of PO. ( cont.) II- Dubousset ( 1991) : 1- Regular PO : spine & pelvis in same directions of deformity. 2- Opposite PO : in opposite directions.

  5. INFRA-PELVIC FIXED PO. A- Congenital hip contracture: 1- cong. Abductor contracture 2- cong. Adduction contracture B- neuromuscular hip contractures : abd, add or both. SUPRA-PELVIC FIXED PO.: - in cong. or neuromuscular scoliosis - not in idiopathic scoliosis ( curve not extend to pelvis )

  6. DISABILITY & SEQUILAE of PO. A- locomotor: Interferes w sitting, standing balance & walking. B- 2ry. Deformities : * spinal : L. scoliosis( cause / result) . Increased L. lordosis. * hip : Abd / add contractures . * knee : hyperextension on long side * apparent LLD. C- decubitus ulceration: ischial / G. trochanter on lower side.

  7. DIAGNOSIS & ASSESSMENT OF PO. HISTORY GENERAL EXAM.: * CARDIOPULMONARY FUNCTION * Gait : - short leg limp ( dipping gait) - Trendlenburg gait EXAM OF DEFORMITY : * inspection * palpation

  8. EXAM for FIXED DEFORMITY: a- Pelvic obliquity: * Oblique pelvis : interspinous line is not perpendicular to midline of body provided that legs are parallel to midline of body * functional PO.; present only when pt. stands with knees straight & no lift under foot & disappear on sitting & on recumbency w legs parallel to midline of body * fixed PO. : persists in all positions & cannot be passively corrected 1- infra-pelvic; overcomed by swining legs to one side or other while recumbent. 2- supra-pelvic; never.

  9. EXAM for FIXED DEFORMITY ( cont): B- Scoliosis: * trunk alignment : plumb line * type of curve * flexibility / rigidity of curve * rotation * neurologic exam. * clinical photographs. C- Fixed hip def. : abd, add, flexion ,rotation

  10. ROM : hip. Spine . Knee. Ankle. NEUROLOGIC EXAM: - Power - specific muscles ( hip / trunk) -sensation MEASUREMENTS : - PO. - LLD ( app / true) - circumference. SPECIAL TESTS : - iliotibial band - hip instability.

  11. Ober test

  12. RADIOLOGIC ASSESSMENT A- Pelvic obliquity : * diagnosis of PO. : - in frontal plane - 3-D * Angle of PO: Osebold , 1982

  13. B- Scoliosis: A- Angle ( Cobb ) B- rotation ( pedicles displac.) C- c rigidity : - side bending - traction - suspension D- Torso decompensation: Osebold E- Pt. maturation : Risser sign LORDOSIS SPINA BIFIDA 2ry changes in hips CT MRI

  14. A- side-bending XR B- suspension XR B A C- traction XR C

  15. Torso decompensation / trunk list

  16. C- MEASUREMENT of LEG LENGTH • Plain X- ray: scanogram • CT OTHER INVESTIGATIONS: * cardiopulmonary * Biochemical ; ms dystrophy

  17. TREATMENT TTT of PO is directed to the specific cause Ttt of functional PO: - by leg length balancing - up to 3 cm LLD ; shoe lift - > 20 cm LLD; orthosis - 3-20 cm LLD; shortening, lengthening or both. * correct bony def. or jt. Contracture 1st.

  18. TTT of infra-pelvic type: A- cong hip contractures: - early ; stretching / traction and spica casting - neglected ; surgical release & splinting. B- Paralytic hip contractures ; surgical - abd contracture by ; 1- soft tissue release ( prox & distal). 2- STR+ erector spinae transplant or 3- STR+ intertroch. femoral osteotomy ; > 3 y old, severe, 3-D - add contracture ;

  19. TTT of supra-pelvic type A- Abdominal fascial plastic operations B- Muscle- tendon transplant operations C- Spinal surgery.

  20. Spinal surgery : Objective: correction of def. to the point at which pelvis is level & then fusion of spine & pelvis in that corrected position. Methods : A- Post. Surgery only; if pelvis can be levelled by passive bending / traction * Harrington sacral bar * Luque * recent segmental instrumentations B- Combined ant. & post . Surgery ; if pelvis can not be levelled by passive bending / traction or deficient post. elements * ant correction& fusion without instrumentation * ant correction& fusion with instrumentation ( Dwyer system).

  21. TTT of combined type A- correct hip & knee def. 1st then spinal fusion, otherwise spinal def will recur [ Barr, 1950 & Turek, 1984] B- Beaty [1992]; when PO is moderate & L. scoliosis is fixed , correct scoliosis w instrumentation 1st.

  22. TTT of PO that cannot be corrected by hip / spinal surgery INDIC.: 1- 2ry osseouship changes or 2ry arthritic changes in L spine rendering full correction impossible. 2- residual significant fixed PO [ 18 deg] METHODS: 1- LL realigning to trunk by femoral osteotomy 2- post iliac osteotomy [ Lindseth,1978]; compensating pelvic def. placing isch tuberosities & acetabla in planes perpendicular to long axis of body 3- ischium excision; partial / complete

  23. postiliacosteotomy[ Lindseth,1978];

More Related