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Triple Osteotomy of the Innominant Bone in a 14 year old girl

BSSMC. Hip Dysplasia. Google Search for Hip DysplasiaVery Common in large breed dogs. BSSMC. DDH. Developmental Dislocation (Dysplasia) of the Hip (DDH)Abnormal formation of the hip jointThe femoral head is not stable in the acetabulum due to improper alignmentMay or may not dislocateUsually detected at birth but not always1-4.

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Triple Osteotomy of the Innominant Bone in a 14 year old girl

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    1. BSSMC Triple Osteotomy of the Innominant Bone in a 14 year old girl Janet Trethewey, EdD, ATC BSSMC 2006

    2. BSSMC Hip Dysplasia Google Search for Hip Dysplasia Very Common in large breed dogs

    3. BSSMC DDH Developmental Dislocation (Dysplasia) of the Hip (DDH) Abnormal formation of the hip joint The femoral head is not stable in the acetabulum due to improper alignment May or may not dislocate Usually detected at birth but not always1-4

    4. BSSMC DDH – Risk Factors Girls1,2 40-60% Left Hip1,9 20% Bilateral9 First Born1 Breech Babies1 Family History2 European origin2

    5. BSSMC DDH-Screening Screening at Birth1-3,6 Physical exam – dislocation or “click” Radiography Well-baby checks Usually detected within first 6 months of life – poorer outcomes the later detected Most literature up to age 3

    6. BSSMC DDH-Treatment Initially if mild or moderate1-2 Triple diapering If sever or non-responsive1-2 Pavlik harness up to 6 months Older than 6 months1-2 Hip spica cast surgery

    7. BSSMC DDH-Prognosis With successful treatment – no further problems1-3 Rare cases – leg length discrepancy due to brace/spica1 Unsuccessful or non-treatment Osteoarthritis leading to hip replacement1-5

    8. BSSMC Case Study 14 Year old Female Youngest of 4 girls Older sister had mild “click” as an infant and was triple diapered No S & S at birth or during prenatal follow-up visits

    9. BSSMC Cont. Became very active at age 12 upon entering Jr. High athletics Began complaining of Right knee pain with activity No swelling Family physician Dx “Growing Pains” Rx activity as tolerated, OTC-NSAID, ice Resolved over summer with decreased activity

    10. BSSMC Cont. Upon second year of activity, knee pain more intense Unable to climb stairs Unable to participate No swelling Referred to Orthopedist “Growing pains” Cont. original Tx

    11. BSSMC Cont. Age 14 – Frosh. Year VB season – some discomfort BB season – sever pain/disability Unable to climb stairs Interfering with sleep Unable to participate Began feeling “pop” in hip

    12. BSSMC Cont. Referred to second orthopedist Mother requested radiographs of entire lower extremity Dx – Developmental Dysplasia of Hip Knee Pain – referred pain from Hip Allowed to continue participation within limits pain and re-eval. at end of season

    13. BSSMC Cont. January, 2005 Hip fully dislocated during practice Referred to specialist for triple osteotomy to reconstruct acetabulum Surgery – Jan. 23, 2005

    14. BSSMC Pre-Op Radiograph

    15. BSSMC Post-op Radiograph

    16. BSSMC Cont. Patient non-weight bearing for 6 weeks Limited weight bearing additional 14 weeks Full weight bearing 5 months post-op. Physical therapy first 12 weeks post-op

    17. BSSMC Follow-up Radiograph

    18. BSSMC Cont. Released for activity approximately June 1, 2005 Continued exercising on own over summer Began VB August, 2005 Knee pain resumed September, 2005 Has grown almost 2” since surgery Restricted from BB season-returned to PT

    19. BSSMC Conclusions Referred Pain Remember to examine entire extremity Follow up No ATC available Physician unfamiliar with activity level Poor communication between physician & PT

    20. BSSMC Cont. Growth should not hurt Pain a symptom of injury Listen to Parents Intuition; know child best Listen to Patient Allow to talk/explain

    21. BSSMC References American Academy of Orthopaedic Surgeons. (2204) Developmental Dislocation (Dysplasia) of the Hip (DDH). Retrieved: 11/23/2005 http://orthoinfo.aaos.org/fact/printer_page.cfm?topcategory=hip&Thread_ID=153. French, L and Dietz, F. (1999) Screening for Developmental Dysplasia of the Hip. American Family Physician. Retrieved: 11/23/2005 http://www.aafp.org/afp/990700ap/177.html. Aronsson, D, Goldberg M, Kling, T and Roy, D. (1994) Developmental dysplasia of the hip. Pediatrics. Retrieved: 11/23/2005 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstr... McCarthy, J, et al. (1996) Innominate Osteotomy in Adolescents and Adults who have Acetabular Dysplasia. The Journal of Bone and Joint Surgery, 78-A.No 10. 1455-1461. Hsin, J, Saluja, R, Eilert, R, and Wiedel, J. (1996) Evaluation of the Biomechanics of the Hip following a Triple Osteotomy of the Innominate Bone. The Journal of Bone and Joint Surgery,78-A, No. 6. 855-862. Complete Human Anatomy, Interactive Series CD. Primal 3D Pictures Ltd.

    22. BSSMC Thank You Robin & Linda Christian Oberquell, ATC Tom Welch Jack Trethewey

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