Novosti
Khirurgii
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Year 2012 Vol. 20 No 6

TRAUMATOLOGY AND ORTHOPEDICS

O.A. SOKOLOVSKY

ORRECTION OF THE COXOFEMORAL JOINT DEFORMITY AFTER AVASCULAR NECROSIS OF THE HIP PROXIMAL SECTION IN CHILDREN

SE Republican Scientific-Practical Center of Traumatology and Orthopedics, Minsk
The Republic of Belarus

Objectives. To establish regularities of the coxofemoral joint deformities development after the avascular necrosis of the hip bone head in children and to determine optimal ways of surgical correction for each type of deformity.
Methods. We studied X-ray patterns of 800 children with the congenital hip disjunction and subluxation in 1057 joints, which were made 12-16 years after the conservative treatment. Avascular necrosis was revealed in 148 cases (12,25%) in 106 patients.
Results. A number of regularities of the coxofemoral joint deformities development after the avascular necrosis (AN) have been established. The approaches based on the obtained data have been stated concerning the operative correction of deformity of the hip proximal section. Varus-detorsion osteotomy is an optimal intervention after the 1st and 2nd type of AN, and at the cavity dysplasia the triple pelvis osteotomy. The posterior rotary osteotomy of the hip bone is the operation of choice at the three-plane hip proximal section deformity. One-stage correction of the pelvis and hip deviations is an optimal one after the 3rd and 4th types of AN. Triple pelvis osteotomy permits to normalize the position of the acetabulum and one of the hip bone osteotomy types the position of the hip proximal section; in case of the three-plane deformity the operation should include the element of roration and in case of high stationary point of the greater trochanter to normalize its position, and after the 4th type of AN to correct varus deformity.
Conclusions. The presence of the AN particular type of the hip proximal section leads to a gradual development of similar coxofemoral joint deformities attributable only to this group. In childhood it is necessary to perform operations taking into account not only the present deviations but also those abnormalities which will unavoidably appear as the result of the continuing functioning of the damaged growth zones of the hip proximal section. Each type of deformity requires the correction of deviations typical for it including multiplane ones.

Keywords: avascular necrosis of the hip head, coxofemoral joint, deformity of the hip proximal section, surgical correction
p. 70 76 of the original issue
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Address for correspondence:
210023, Respublika Belarus, g. Minsk, ul. Kizhevatova 60/4, GU Respublikanskiy nauchno-prakticheskiy tsentr travmatologii i ortopedii, laboratoriya travmatologii i ortopedii detskogo i podrostkovogo vozrasta,
e-mail: sakalouski@yandex.ru,
Sokolovskiy Oleg Anatolevich
Information about the authors:
Sokolovsky O.A. Doctor of medical sciences, head of the laboratory of the childhood and adolescence traumatology and orthopedics of SE Republican Scientific-Practical Center of Traumatology and Orthopedics.
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