Content
Abstract of
the article: Youssef AO. Medial approach open reduction with ligamentum teres partial
excision and plication for the management of congenital hip dislocation (2018).
The article describes a method for transposition of the proximal attachment of
the ligamentum capitis femoris (LCF) in congenital hip dislocation. The text in
Russian is available at the following link: 2018YoussefAO.
Abstract
Because of the known tendency for early redislocation
following open reduction, we developed surgical methods for shortening the
ligamentum teres to improve immediate postoperative stability when performing
medial approach open reduction (MAOR) for the management of developmental dysplasia
of the hip. Between 2004 and 2014, 32 patients with dysplasia of the hip were
managed by MAOR with partial excision and plication of ligamentum teres. The
patients were followed up for an average of 6.9 years. At the final follow-up,
clinical outcomes achieved were categorized as excellent and good in 39 (39/40;
97.5%) hips. At the latest follow-up, 97.5% (39 hips) were classified as good
or excellent on the basis of the Severin classification (Severin grade 1 or 2).
In conclusion, this series of MAOR, in which ligamentum teres partial excision
and plication was utilized, we found stable reduction in all hips. On the basis
of these positive results, we recommend this method for children treated with
MAOR.
Level of
evidence: IV, case series.
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Youssef AO.
Medial approach open reduction with ligamentum teres partial excision and
plication for the management of congenital hip dislocation. J Pediatr Orthop B.
2018;27(3)244-9. DOI: 10.1097/BPB.0000000000000455 journals.lww.com
, pubmed.ncbi.nlm.nih.gov
Surgical
technique
The
approach is similar to that described by Weinstein and Ponseti [10]. A 3 cm
incision is made parallel to and 1 cm distal to the groin crease, centered on
the adductor longus. The tendon of the adductor longus is divided, close to the
pubic tubercle, and allowed to retract. The anterior branch of the obturator
nerve is then identified and traced between the adductor brevis and the
pectineus. When this interval is developed, the medial circumflex vessels can
be identified and protected by gentle retraction. The psoas tendon is divided
at its insertion to the lesser trochanter, and the capsule is opened in a
T-fashion. Care was taken to ensure that the long limb of the T continued
beneath the vessels as far as the synovial reflection. The ligamentum teres is
identified and retracted, the bulk of the pulvinar is cleared, and the limbus
is everted if necessary. The femoral head is then delivered into the acetabulum
and the ligamentum teres is divided into two halves. One half is excised and
the other half is sutured side-to-side by 1.00 vicryl sutures (Fig. 1). The
incision is closed in layers. Bilateral cases were operated in the same
sitting. A double hip spica is applied with the hips flexed 100° and abducted 40°–60°,
for 12 weeks, changed under general anesthesia after 6 weeks. Plain radiographs
confirmed the quality of the reduction.
Ahmed O Youssef – Department
of Orthopedic Surgery, Faculty of Medicine, Minia University, Minia, Egypt.
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, pathology, congenital dislocation, dislocation, plastic surgery, reconstruction, open plastic surgery
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