How are outcomes affected by combining the Pemberton and Salter osteotomies?

MH Metin Sabanci Baltalimani Hospital for Research and Education, Istanbul, Turkey.
Clinical Orthopaedics and Related Research (Impact Factor: 2.88). 05/2008; 466(4):837-46. DOI: 10.1007/s11999-008-0153-3
Source: PubMed

ABSTRACT The Pembersal operation combines features of the Pemberton and Salter osteotomies. Results have usually been reported in patients with dysplasia but without frank dislocation. We asked if the following factors influence the outcome of the Pembersal operation in patients with dislocated hips: triradiate cartilage damage causing early closure; the acetabular index improvement; and the age of the patient at time of operation. We assessed triradiate cartilage damage, a modified McKay clinical classification, acetabular index, center-edge angles, Reimers index, acetabular depth-to-width ratios, Severin classification and Tönnis grading of 33 patients (44 hips) have been evaluated in this retrospective study. The mean age at surgery was 5 years (range, 1.5-14 years). The minimum followup was 5 years (mean, 10.5 years; range, 5-17 years). Preoperatively, three (7%) hips were Tönnis Grade 2, 10 (23%) were Grade 3, and 31 (70%) were Grade 4. Eight (18%) hips were Severin Class 1, 32 (73%) Class 2, and four (9%) were Class 3. According to McKay's criteria satisfactory results with a rate of 76% were obtained. Premature closure of the triradiate cartilage occurred in eight (18%) hips and postoperative avascular necrosis of the femoral head in three (6%) hips. Satisfactory clinical and radiographic improvements in the aforementioned parameters can be obtained by Pembersal osteotomy. LEVEL OF EVIDENCE: Level IV, therapeutic case series. See the Guidelines for Authors for a complete description of levels of evidence.

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    ABSTRACT: Background: Loss to follow-up weakens study results, but 100% patient return is typically unrealistic, especially in retrospective call-back studies. What follow-up rate should investigators strive to obtain? No articles evaluating this question could be found in a PubMed literature search. Thus, we proposed to identify an average rate of patient return in pediatric orthopaedic retrospective call-back studies. Methods: A PubMed literature search was conducted to identify pediatric orthopaedic retrospective call-back studies. The search was limited to orthopaedic journals, in which the titles and abstracts contained the key word, “retrospective.” The search also was limited to publications from 1999 through 2010 and in patient groups with an average age of 18 years old or younger. The search results were then reviewed to identify only call-back studies in which the authors clearly cited attempts at contacting patients for further data collection. Articles with insufficient data, fewer than 10 patients, or an average patient age over 18 years at time of treatment were excluded. The rate of follow-up, study location, length of follow-up, patient age, number of patients, and data collection methods were all recorded and analyzed statistically. Results: The PubMed search identified 1496 articles; 55 articles (59 cohorts) remained after application of the exclusion criteria. The average rate of patient follow-up was 69%, with considerable variability (SD±20%). Studies with more than 40 patients (64%) had poorer follow-up rates than those with fewer than 40 patients (76%) (P=0.014) and non-US articles (74%) trended toward better follow-up rates than US (64%) publications (P=0.06). Length of follow-up trended toward better follow-up with short-term studies, but this was not statistically significant (P=0.085). Conclusions: Retrospective call-back studies present challenges in obtaining further patient data. The patient population size and study location were two factors shown to affect follow-up rates. Interestingly, the length of follow-up did not significantly affect patient return rates. The average follow-up rate found in this study based on extensive literature review, 69%, may provide a general target for future publications of the same design. However, significant variation exists, and further investigation is needed to establish publication standards.
    Current Orthopaedic Practice 01/2012; 23(6):590-594. DOI:10.1097/BCO.0b013e31826efee5
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    ABSTRACT: OBJETIVO: Avaliar os resultados do tratamento cirúrgico da Displasia do Desenvolvimento do Quadril na idade da marcha. MÉTODOS: Avaliamos 33 quadris operados entre novembro de 1992 e setembro de 1997. A média de idade foi 4 anos e 5 meses na ocasião da cirurgia e 11 anos e 7 meses quando avaliamos os resultados. O seguimento médio foi de 10 anos e 2 meses. Realizamos o encurtamento femoral, redução cruenta e osteotomia pélvica (Salter ou Chiari). Radiograficamente avaliamos: grau da luxação, índice acetabular; ângulo acetabular; arco de Shenton; linha de Hilgenheiner; coeficientes c/b, c/h, centro-acetábulo e cabeça-acetábulo; largura da cartilagem trirradiada; relação cabeça trocânter; esfericidade da epífise femoral; ângulo de Wiberg; necrose avascular e anisomelia. Os parâmetros radiográficos foram avaliados nos períodos pré-operatório, pós-operatório imediato e tardio. RESULTADOS: Verificamos estatisticamente melhora significante destes no momento pré-operatório para o pós-operatório imediato (p=0,0001) porém não houve variação significante entre o pós-operatório imediato e o tardio (p=0.5958). CONCLUSÃO: Pela classificação utilizada para avaliação dos resultados observamos 23 (69,70%) bons, 5 (15,15%) regulares e 5 (15,15%) maus resultados.
    Acta Ortopédica Brasileira 12/2009; 18(4):218-223. · 0.16 Impact Factor
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    ABSTRACT: Background: Two-dimensional (2D) measurements of acetabular morphology and orientation are well known; there is less information on these acetabular characteristics in three dimensions. One important reason is the lack of standardized reference planes for the pelvis, especially in relation to the spinopelvic unit; another is that no method precisely assesses the acetabulum in three-dimensional (3D) orientation based on its axis rather than on the directions of the edges of the acetabular rim. We present an objective, highly reliable and accurate, axis-based approach to acetabular anthropometry in the measurement of acetabular volume and spatial orientation in both normal and pathologic hips. This was done using reference planes based on the sacral base (SB) and true acetabular axis in 3D computed tomography (CT) pelvic reconstruction. Methods: Radiological examinations of 30 physiologic pelves (60 acetabula) were included in the study. Reliability and accuracy of the method were verified by comparing acetabular angles in 2D pelvic scans with 3D reconstructions. We also applied the method to two pathologic acetabula. Results: Comparison of axis position in the horizontal plane revealed significant positive correlations between 2D angle measurements (acetabular anteversion angle [AAA] and anterior acetabular index [AAI]) and 3D measurement of anteversion angle (p < 0.001 and p = 0.012, respectively). In the frontal plane, there was no difference between abduction angle, measured on topogram, and inclination angle, obtained from a 3D model (p = 0.517). In the sagittal plane, there was a significant negative correlation between AAA and acetabular tilt (p < 0.001). Inter- and intra-observer reproducibility was excellent for determination of the sacral-base plane and assessment of volume, with Fleiss κ coefficients of 0.850 and 0.783, respectively, and intraclass correlation coefficients of 0.900 and 0.950, respectively. Inter-observer reproducibility for evaluation of acetabular axis ranged from 0.783 to 0.883, and intra-rater reliability ranged from 0.850 to 0.900 for all 3D angles. Conclusions: Our method is a new, reliable diagnostic tool for assessing the acetabula in both normal and pathologic hip joints. The sacral-base plane can be used as a stable reference that takes the relationship of the acetabulum to the spinopelvic unit into consideration. Keywords: Acetabulum, Three-dimensional reconstruction, Hip dysplasia, Spastic hip disease, Rapid prototyping
    BMC Musculoskeletal Disorders 02/2015; 16(1):42-51. DOI:10.1186/s12891-015-0503-8 · 1.90 Impact Factor

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