Six adolescent patients with acetabular dysplasia and femoral head subluxation were treated with Chiari osteotomy. The average age of the children was 14 years. The prior duration of the subluxation and dysplasia had resulted in mutual remodeling adaptations preventing concentric femoral head restoration. The Chiari osteotomy improved acetabular cover without significantly disturbing hip mobility in the existing modeling relationship. Postsurgical morbidity included delay in osteotomy healing, wound infection and sciatic nerve damage. Proper care was necessary to outline the osteotomy site so that the proximal iliac segment lay in proper juxtaposition for femoral head support after displacement. A variety of treatment choices is available for this category of hip derangement. The advantages and disadvantages of the Chiari osteotomy were listed.

Acetabulum↗

PubMedDate not supplied

Nonarticular osteochondroses.

Nonarticular osteochondroses represent disordered enchondral ossification of epiphysis or apophysis at specific sites of muscle/tendon insertions or ligament attachments. Traditionally, osteochondroses have been identified by eponymic proper names. A generic classification is based upon the relationship of excessive or repetitive traction in occasional combination with direct pressure at discrete anatomical sites. The following are models of the several varieties: Osgood-Schlatter syndrome, typifying muscle/tendon stress on the tibial tuberosity; medial epicondylosis (Adams), resulting from forearm and elbow stress generated by muscles and creating traction through the ulnar collateral ligament attachment; and Sever's syndrome (calcaneal apophysis), associated with tension at either end of the calcaneal apophysis in combination with direct impact pressure. The general characteristics of this group include symptoms of pain or tenderness, timed appearance coincident with the developmental sequence of the apophysis, and generally symptomatic management.

Adolescent↗

PubMedDate not supplied

Late modelling changes in Legg-Calvé-Perthes disease (LCPD) with continuing growth to maturity.

The changes occurring with hip bone growth in the typical case of LCPD consist of (1) lack of additional growth in height of the affected femoral capital epiphysis; (2) further increase in femoral capital epiphyseal width over that present at treatment termination, i.e., 4 mm to 7.2 mm; (3) diminution in length of the femoral neck of 11.5 mm over that of the unaffected hip; (4) an almost universal alteration of the plane of the proximal femoral growth plate from linearity to convexity and scattered instances of partial growth plate slowing affecting either the medial or lateral sectors; (5) change of neck-shaft angle from 132 degrees on the unaffected side to 128 degrees on the involved side; there were almost equal instances of partial depression either of the medial or lateral growth plate margins; when the growth of the medial portion was slowed or suppressed, the neck-shaft angle lessened and when the lateral side slowed, the neck-shaft angle increased; (6) diminution in the articular-trochanteric (A-T) difference on the affected side, i.e., 9.5 mm in comparison with 16.8 mm on the intact side; 2 major factors in this lessening of the A-T distance (or conversely, increase in trochanteric height) were slowing of growth of femoral neck while that of the greater trochanter continued normally and diminution in the neck-shaft angle; (7) alteration in the final result rating in Catterall IV group--one poor to fair: Catterall III group--one poor to fair and 2 fair to poor: Catterall II group--no change from good.

Adolescent↗