We evaluated the percentage of patients with acetabular labral tears who have a structural hip abnormality detectable by conventional radiography. Records from our institution from 1996 through 2002 were reviewed to identify all patients with labral tears. Patients were excluded who had classic hip dysplasia, advanced osteoarthritis, or a history of pelvic or femoral osteotomy. The hip radiographs were evaluated for abnormalities of Tonnis angle, center-edge angle of Wiberg, acetabular version, femoral neck-shaft angle, congruency between the femoral head and acetabulum, anterior femoral head-neck offset, and presence of femoral head osteophytes. Twenty-seven of the 31 patients (87%) had at least one abnormal finding and 35% had more than one abnormality. Ten patients had a retroverted acetabulum, 16 had coxa valga, 11 had an abnormal femoral head-neck offset, and 14 had osteophytes on the femoral head. Four of 31 patients (13%) had no identifiable structural abnormalities. To our knowledge, this is the first study to document that the majority of patients with labral tears have a structural hip abnormality detectable with conventional radiographs. Familiarity with these structural abnormalities is important for early detection and accurate diagnosis, and may impact optimal treatment planning and prognosis.

Acetabular labral tears rarely occur in the absence of bony abnormalities.

Ilizarov embarked on his remarkable medical career as a general practitioner in the small industrial town of Kurgan, Siberia, after World War II69,75,96 Antibiotics were scarce, and chronic osteomyelitis associated with loss of bone, non-unions, and skeletal deformities were so common that Ilizarov found himself practicing orthopaedics although he had had no formal training in that specialty With the use of modular-ring external fixators and transosseous wires attached to the rings under tension to stabilize the bone fragments, he introduced the concept of induction of local bone formation with a minimally invasive procedure69,75,96 Ilizarov coined the term distraction osteogenesis to describe the induction of new-bone formation between osseous surfaces that are gradually pulled apart9 His clinical successes in the salvage of limbs that would otherwise have been amputated and in the return of disabled patients to productive levels of activity eventually spread by word of mouth throughout the Communist bloc of countries69,75 By 1981, a group of Italian orthopaedic surgeons had learned of his technique9 More recently, the method was introduced in North America, where it has been adopted primarily for limb-lengthening12,49,120,125 and the correction of limb deformities as well as the treatment of non-unions and bone loss secondary to trauma, infection, or tumor39,41,43,46,76,78,99,114,124,135,142

Ilizarov practiced in an isolated area of the world without access to the many technological and medical advances that took place during the four decades after World War II As a result, he relied on distraction osteogenesis to treat a variety of musculoskeletal conditions The reconstruction of …

Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(98)01302-6.pdf

Natural history of scoliosis in spastic cerebral palsy

We reviewed the results of distraction osteogenesis of 114 femora and 147 tibiae that had been lengthened to treat a variety of diagnoses. The femora had been lengthened an average of eleven centimeters (range, 3.5 to 17.0 centimeters), or 48 per cent (range, 8 to 86 per cent) of the original femoral length. The average total time for the treatment of the femora (use of the fixator and any subsequent immobilization) was 257 days (range, 105 to 420 days). There were 114 complications related to the femoral lengthenings, which led to eighty-seven additional operations. The tibiae were lengthened an average of nine centimeters (range, 3.0 to 15.6 centimeters), or 41 per cent (range, 9 to 100 per cent) of the original tibial length. The average total time for the treatment of the tibiae was 268 days (range, 110 to 497 days). There were 196 complications related to the tibial lengthenings, which led to 219 additional operations. The Achilles tendon was lengthened during or after seventy-three (50 per cent) of the tibial lengthenings. The femoral lengthenings that were performed to treat a limb-length discrepancy were associated with significantly higher rates of complications overall (p = 0.010) and additional operations (p = 0.023) for each percentage of length gained than those that were performed to treat achondroplasia or another skeletal dysplasia. The femoral lengthenings that were performed to treat short stature (of an endocrine or idiopathic etiology) were also associated with higher rates of complications overall and additional operations than those performed to treat skeletal dysplasias, but the rates were lower than those for lengthenings performed to treat limb-length discrepancy. The rate of complications overall associated with femoral lengthening in patients who were fourteen years old or more was significantly higher than that associated with lengthening in patients who were less than fourteen years old (p = 0.047). Femoral lengthening through the metaphysis was associated with significantly higher rates of complications overall (p = 0.031) and additional operations (p = 0.042) for each percentage of length gained than femoral lengthening through the diaphysis. The tibial lengthenings that were performed to treat Turner syndrome and idiopathic short stature were associated with significantly higher rates of complications overall (p = 0.026) and additional operations (p = 0.003) for each percentage of length gained than those performed to treat skeletal dysplasias. The rate of joint-related problems (p = 0.044) and that of additional operations (p = 0.053) after tibial lengthening in patients who were fourteen years old or more were significantly higher than those rates after tibial lengthening in patients who were less than fourteen years old. The site of the tibial osteotomy did not affect the rate of complications or additional operations. The femoral healing indices (in terms of both days per centimeter [p = 0.002] and days for each percentage of length gained [p = 0.019]) were significantly higher in the patients who were fourteen years old or more than in those who were less the fourteen years old. These values could not be used to predict an increase in the complications because of poor bone formation. The results of the present review suggest that the use of healing indices to gauge the final outcome of distraction osteogenesis is questionable; we were unable to discern significance or clinical importance from appropriately adjusted values.

Distraction Osteogenesis of the Lower Extremity with Use of Monolateral External Fixation. A Study of Two Hundred and Sixty-one Femora and Tibiae*

/pdf/distraction-osteogenesis-of-the-lower-extremity-with-use-of-1hqkcq5wwq.pdf

Distraction osteogenesis of the lower extremity with use of monolateral external fixation

Arthroscopy of the hip joint was performed in 19 children with Legg-Calve-Perthes' disease. Proliferation of the synovium was pronounced both in the acetabular fossa and over the inner wall of the capsule. Hypervascularity was seen on the acetabular labrum in every stage of the disease. Microscopically, hyperplasia of the synovial lining cells was observed, but inflammatory changes in the synovial tissue were inconspicuous in the early stage of the disease. Although hypertrophy of the endothelial cells of the vessels was seen in the late stage of the disease, it was not distinct in the initial or fragmentation stages. Joint pain improved after irrigation during arthroscopy.

Arthroscopy in 19 children with Perthes' disease Pathologic changes of the synovium and the joint surface

Femoral lengthening by callus distraction was performed on 26 femurs of 18 patients with various disorders between 1988 and 1992. Age at surgery ranged from 6 to 17 years (13 years on average). The amount of lengthening varied from 2 to 7.5 cm (mean 5 cm). Follow-up evaluation of femoral-head displacement was based on the change of center-edge (CE) angle. The hips were divided into two groups based on the preoperative CE angle; one group consisted of 14 hips with a CE angle > 20 degrees and the other group consisted of 12 hips with an angle of < or = 20 degrees. In the first group, none of the hips deteriorated; however, five of 12 hips in the second group did deteriorate. One hip developed complete dislocation and the other four showed a decrease in the CE angle. Four of five deteriorated hips had a history of congenital dislocation of the hip and the other had multiple epiphyseal dysplasia. In cases in which the CE angle is < or = 20 degrees preoperatively, bony procedures such as innominate osteotomy should precede femoral elongation.

Dislocation and subluxation during femoral lengthening.

The authors analyzed lateral deviation, anteroposterior deformity, and rotation of the spinal column of 11 patients with scoliosis associated with cerebral palsy (CP) and 11 patients with progressive muscular dystrophy (PMD). There was a correlation between the magnitude of Cobb angle and that of the vertebral rotation in scoliosis associated with both CP and PMD, but the ratio of spinal rotation to Cobb angle in the former was lower than that in the latter, The magnitudes of thoracic kyphosis and of lumbar lordosis were not correlated with Cobb angle in either group, but the sagittal plane deformity in the CP patients was less severe than that in the PMD patients, and the latter demonstrated kyphosis of the lumbar spine and lordosis of the thoracic spine.

Kengo Furukawa

Papers

Arthroscopy in 19 children with Perthes' disease Pathologic changes of the synovium and the joint surface

Dislocation and subluxation during femoral lengthening.

Three-dimensional spinal deformity in scoliosis associated with cerebral palsy and with progressive muscular dystrophy.