Journal of pediatric orthopedics
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Femoral head containment in Legg-Calvé-Perthes disease (LCPD) can be either surgical or nonsurgical. The Salter or innominate osteotomy is a common method of surgical containment. This is a review of the technique and results of this osteotomy in LCPD. ⋯ The Salter osteotomy in LCPD is an effective method of surgical treatment that can alter the natural history of the disease process. The main advantage of this osteotomy is its effect on femoral head remodeling during remaining growth.
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Comparative Study
Labral support shelf arthroplasty for containment in early stages of Legg-Calve-Perthes disease.
Containment of the hip has become a popular strategy for treatment of severe Legg-Calve-Perthes disease; however, the best method remains unclear. This study describes a minimal-incision variation of the labral support shelf arthroplasty, which uses arthroscopic visualization and an allograft buttress on the shelf support. The outcome in a group of hips undergoing this minimal-incision variation is compared by the Stulberg classification with a group treated by the traditional anterolateral open operative approach. In addition, the outcomes of both groups of labral support shelf arthroplasties are compared then with other containment techniques used in our hospital consisting of Petric cast, varus femoral osteotomy, and innominate osteotomy of Salter. ⋯ The labral support shelf arthroplasty by either the traditional method or the minimal-incision variation offers similar Waldenstrom class outcomes when compared with a Petric cast, a varus femoral osteotomy, or an innominate osteotomy of Salter. We believe the labral support shelf arthroplasty technique is simple to perform and does not induce a permanent deformity in the proximal femur or acetubulum.
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There are concerns of potential growth disturbance after transphyseal reconstruction of the anterior cruciate ligament in skeletally immature patients. The authors used magnetic resonance (MR) imaging to evaluate growth disturbance and associated physeal abnormalities after index surgery. ⋯ Retrospective Case Series, Therapeutic Level IV.
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The goal of intervention in Legg-Calvé-Perthes disease has been to prevent femoral head deformation by containing the head within the acetabulum, using it as a mold for guiding femoral head development. With appropriate proximal femoral morphology, premature arthritis can hopefully be avoided. Both nonsurgical and surgical methods of treatment have evolved over time, from abduction casts and braces to advanced surgical containment methods, which are now the mainstay of treatment. The purpose of this study is to briefly review the evolution of surgical treatment of Legg-Calvé-Perthes disease, and to concentrate on 2 advanced surgical containment methods: combined Salter innominate osteotomy with femoral varus osteotomy and triple pelvic osteotomy.
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Review Historical Article
A brief history of Legg-Calvé-Perthes disease.
Legg-Calvé-Perthes (LCP) disease has an extensive history that has provided an ongoing intellectual challenge for the orthopaedic community. Debate around etiology and treatment of LCP disease continues even after its initial description in the early 1900 s. In order for modern day clinicians to have a full understanding of the condition, one must be a scholar of its development. The purpose of our review will be to discuss the scientific communities' understanding of presentation, etiology, and treatment of LCP disease over time.