Failed vascularized proximal fibular epiphyseal transfer for hip reconstruction following infection in children

Journal of Children's Orthopaedics - 2009
R. Debarge1,2, Franck Chotel1, Aram Gazarian1, Jérémy Viola1, J Bérard1
1The Department of Pediatrics Orthopedic Surgery, Hôpital Universitaire Femme Mère Enfant de Lyon, 59 bd Pinel, 69677, Bron France
22 montée du Vernay, 69300, Caluire France

Tóm tắt

Purpose Treatment of the sequellae of hip infection with epiphyseal destruction in children has had limited success to date. The aim of this study was to report mid-term results after hip epiphyseal reconstruction using a proximal vascularized fibular graft in three children presenting with massive epiphyseal destruction of the proximal femur following infection. Methods Three children suffered from hip articular destruction type IVB according to the Choi classification after neonatal septic arthritis. The mean age at reconstruction was 4.3 years (range 3–6 years). The Hunka et al. criteria were used to evaluate the functional results, and the clinical evaluation was based on the Musculo-Skeletal Tumor Society (MSTS) score. Growth and fusion of the graft and hip morphology were evaluated on simple X-rays and by magnetic resonance imaging (MRI). A ratio between cephalic diameter and inter-acetabular gap was defined on the MRI scan as the “acetabular filling index”. Results No intraoperative complication was reported. With a mean follow-up of 4.8 years (3–6 years), the MSTS score was 22.7/30 (range 20–26), while the average lower limb length discrepancy was 3 cm. Patient 1 required a secondary derotation osteotomy of the femur because of abnormal external rotation and a bad result due to the unexplained occurrence of a painful and stiff hip joint. A secondary distal transfer of the greater trochanter was performed in patient 2, and good results based on Hunka et al.'s criteria were achieved. The X-rays of patients 1 and 2 showed signs of bone growth and a major remodeling process; the MRI filling indices were 83 and 67%, respectively. Patient 3 developed an early slipped capital (fibular) epiphysis 1 month postoperatively, which was treated by percutaneous pinning; this early complication led to a bad result with full resorption of the graft. Conclusions In contrast to its success in upper limb reconstruction, in this series of three patients with hip articular destruction, articular reconstruction using a vascularized proximal fibula graft was disappointing and led to unsatisfactory results in terms of hip reconstruction. Such a procedure is complex and highly demanding, necessitating extremely intensive post-operative care. An early slipped capital epiphysis can lead to full graft resorption. Consequently, despite important adaptation and remodeling of the graft, the authors do not recommend this procedure at this location.

Từ khóa


Tài liệu tham khảo

10.1016/S0030-5898(20)31496-6

10.1097/01241398-198805000-00013

Lloyd-Roberts GC, 1979, Aust Paediatr J, 15, 41

10.1097/01241398-198309000-00008

10.2106/00004623-199072080-00005

Cheng JC, 1995, Clin Orthop Relat Res, 314, 214

10.1302/0301-620X.66B3.6725339

10.1097/bpo.0b013e31815a606f

10.1016/j.ocl.2006.10.003

10.1016/S0140-6736(03)12192-7

10.1097/BPO.0b013e31817bb079

10.1097/01241398-199005000-00014

10.1097/00003086-198211000-00004

10.1097/00003086-199301000-00035

10.1302/0301-620X.71B3.2722923

10.1097/01.blo.0000063782.32430.37

10.2106/JBJS.C.00713

10.1097/01241398-200303000-00006

10.1097/bpo.0b013e31802b711c

Hallel T, 1978, Clin Orthop Relat Res, 132, 115

Innocenti M, 2005, J Bone Joint Surg Am, 87, 237, 10.2106/JBJS.E.00295

Thông tin
Thông tin xuất bản

Journal of Children's Orthopaedics

Thông tin tác giả