The ComplicationsOF DDH (Avascular Necrosis)

1. The ComplicationsOF DDH (Avascular Necrosis) DAMASCUS HOSPITAL Dr.MHD BASHAR ALBOSHI

2. Open reduction with femoral shortening • ضغط شديد يطبق على رأس الفخذ((عادة يمكن إجراء إفتراق عدة ملمترات بدون تشكيل قوة شد أكبر)) • يجرى عند الأطفال<2سنة

3. Femoral Shortening and Derotation Osteotomy combined with Open Reduction of the Hip • The amount of shortening: distance between the inferior margin of the femoral head and the floor of the acetabulum OR measure the overlap of the osteotomized segments after reduction .

4. The Complications(Avascular Necrosis) • تحدث عند تشكيل ضغط شديد excessive pressureعلى رأس الفخذ.

5. The Complications(Avascular Necrosis) التشخيص DIAGNOSIS : • فشل التكلس أو النمو خلال سنة. • زيادة عرض عنق الفخذ • تغيرات بكثافة العظم. • تشوه( اضطرابات نمو)

7. Classif…..table15-5

16. Interrvention to alter the effects of AVN: • Trochanteric Epiphysiodesis. • Trochanteric Advancement. • Intertrochanteric Double Osteotomy. • Lateral Closing Wedge Valgus Osteotomy With Trochanteric Advancement.

17. Interrvention to alter the effects of AVN: • Trochanteric Epiphysiodesis. • Trochanteric Advancement. • Intertrochanteric Double Osteotomy. • Lateral Closing Wedge Valgus Osteotomy With Trochanteric Advancement.

18. Greater Trochanteric Epiphysiodesis • (Langenskiold) • Be done when major AVN is recognized and the ossific nucleus of the greater trochanteric present. • The most effective if performed when the child is around 5 yrs old. • Ineffective if done when the child is much more than 8 yrs old.

22. Distal And Lateral Transfer Of • Greater Trochanter • Be considered : • when an objectionable abductor limp results from trochanteric overgrowth. • when the greater trochanter reached the level of the top of the femoral head. • Concentric reduction of the hip. • Trendelenburge’s sign (+). • Child > 8 yrs

27. Latersl Advacement Of The Greater Trochanter

28. Wagner’s Intertrochanteric Double Osteotomy

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31. Teratological Dislocations • A teratological dislocation of the hip is one that occurs sometime before birth, resulting in significant anatomical distortion and resistance to treatment. • It often occurs with other conditions such as arthrogryposis, Larsen syndrome, myelomeningocele, and diastrophic dwarfism. • The anatomical changes in teratological dislocations are much more advanced. The acetabulum is small, with an oblique or flattened roof, the ligamentum teres is thickened, and the femoral head is of variable size and may be flattened on the medial side ,The hip joint is stiff and irreducible, and roentgenograms show superolateral displacement. • Most authors agree that closed reduction is not effective and that open reduction is necessary.

32. Teratological Dislocations • A teratological dislocation of the hip is one that occurs sometime before birth, resulting in significant anatomical distortion and resistance to treatment. • It often occurs with other conditions such as arthrogryposis, Larsen syndrome, myelomeningocele, and diastrophic dwarfism. • The anatomical changes in teratological dislocations are much more advanced. The acetabulum is small, with an oblique or flattened roof, the ligamentum teres is thickened, and the femoral head is of variable size and may be flattened on the medial side ,The hip joint is stiff and irreducible, and roentgenograms show superolateral displacement. • Most authors agree that closed reduction is not effective and that open reduction is necessary.

33. Teratological dislocation of left hip in 18-month-old girl. B, Appearance at 3 years of age after primary femoral shortening, anterior open reduction, and innominate osteotomy.

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35. MoKazem.com • هذه المحاضرة هي من سلسلة محاضرات تم إعدادها و تقديمها من قبل الأطباء المقيمين في شعبة الجراحة العظمية في مشفى دمشق, تحت إشراف د. بشار ميرعلي. • الموقع غير مسؤول عن الأخطاء الواردة في هذه المحاضرة. • This lecture is one of a series of lectures were prepared and presented by residents in the department of orthopedics in Damascus hospital, under the supervision of Dr. Bashar Mirali. • This site is not responsible of any mistake may exist in this lecture. Dr. Muayad Kadhim د. مؤيد كاظم