By Robert Bourne
The needs of this publication is to offer an outline of controversies that orthopaedic surgeons may need to contemplate while conducting all degrees of hip surgery.Contributions conceal such very important paediatric difficulties equivalent to developmental dysplasia of the hip, Perthes ailment, slipped capital femoral epiphysis and hip difficulties linked to neurological illnesses. annoying stipulations of the hip, together with acetabular fractures and femoral neck fractures are lined intimately. significant emphasis is given to the sphere of either basically and revision overall hip substitute, with specified emphasis at the distinction which take place in Europe and North the USA. like all different point of hip affliction, the sector of overall hip anthroplasty is constantly altering to enhance either the standard and sturdiness of the medical end result. eventually, post-operative issues and their avoidance are coated, quite within the fields of deep vein thrombosis prophylaxis and administration of the contaminated overall hip arhtroplasty. The contributions during this quantity are from a world array of specialists within the box of hip surgical procedure.
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Extra resources for Controversies in Hip Surgery (Controversies in Orthopaedic Surgery Series)
Some of the confusion about classification has to do with terminology. A commonly used term is femoral head ‘involvement’. What does this mean? In the early ‘avascular’ phase of the disease an MRI or a bone scan will show the entire femoral head to be ischaemic. Radiographs in the initial phase usually show uniform increased density throughout the femoral head. Total head involvement would be a safe conclusion (Fig. 1). However, as the femoral head begins to fragment, several different patterns emerge.
Results of treatment Now for the real controversy. The treatment of Legg–Perthes disease remains the most controversial area within paediatric orthopaedics today. Many of my colleagues feel that it is usually a benign disease and that the more severe cases will not be improved by treatment. Their philosophy usually results in symptomatic treatment such as rest, traction, anti-inflamatory agents, and an occasional intervention to improve range of motion. A second philosophy is that which focuses on range of motion.
The relationship of premanipulation traction and age to avascular necrosis of the femoral head. Journal of Bone and Joint Surgery [Am] 59: 306 –11, 1977. DeRosa GP, Feller N: Treatment of congenital dislocation of the hip. Management before walking age. Clinical Orthopaedics and Related Research 225: 77–85, 1987. Fish DN, Hezenberg JE, Hensinger RN: Current practice in the use of prerreduction traction for congenital dislocation of the hip. Journal of Pediatric Orthopaedics 11: 149–53, 1991. Salter RB, Kostiuk J, Dallas S: Avascular necrosis of the femoral head as a complication of treatment for congenital dislocation of the hip in young children: a clinical and experimental investigation.
Controversies in Hip Surgery (Controversies in Orthopaedic Surgery Series) by Robert Bourne
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