Purpose: Osteonecrosis of the femoral head (ONFH) is common in skeletally immature patients. The management of ONFH is controversial, with limited evidence and unpredictable results. This study systematically reviewed the current operative modalities and clinical outcomes of surgical management for ONFH in skeletally immature patients.
Methods: The present study was conducted according to the PRISMA 2020 guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in October 2021. All the published clinical studies reporting data concerning the surgical management of ONFH in skeletally immature patients were included.
Results: This review included 122 patients (127 hips). 38.2% (46 of 122) were female. The mean age of the patients was 14.2 ± 2.3 years. The mean duration of the follow-up was 55.3 ± 19.6 months. The Harris Hip Score improved from 68.8 ± 11.9 at baseline to 90.5 ± 6.5 at last follow-up ( < 0.0001). Femoral head collapse and secondary hip degeneration were the most common complications.
Conclusion: Several surgical techniques are available and effective for the management of ONFH in skeletally immature patients. This study evidenced high heterogeneity of the surgical procedures and eligibility criteria. Further high-quality investigations are required to establish proper indications and surgical modalities.
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http://dx.doi.org/10.3390/life12020179 | DOI Listing |
Arthrosc Tech
December 2024
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
The medial patellofemoral complex provides the primary static restraint to lateral patellar translation and is composed of the medial patellofemoral ligament and medial quadriceps tendon femoral ligament. Multiple techniques including medial patellofemoral ligament and/or medial quadriceps tendon femoral ligament reconstruction have demonstrated good results; however, modification of the femoral fixation technique is required for skeletally immature patients or revision cases in which anatomic bony fixation on the femur is not possible. This technique describes an all-soft-tissue procedure for single-bundle medial patellofemoral complex reconstruction in which the graft is fixed on the adductor tendon while using the medial collateral ligament as a distalizing pulley, for anatomic and isometric recreation of the native ligament.
View Article and Find Full Text PDFJ Orthop Trauma
January 2025
Geisinger Health System, Department of Orthopaedic Surgery, Danville, PA.
Objectives: To explore outcomes after tibial rigid intramedullary nailing (RIMN) in skeletally immature patients, with a focus on post-operative complications and iatrogenic changes in tibial slope due to anterior physeal arrest.
Methods: Design: Retrospective case series.
Setting: A large, tertiary care health system in the rural Mid-Atlantic United States, including two Level 1 trauma centers and one Level 2 trauma center.
Children (Basel)
November 2024
Service of Traumatology and Orthopaedics Surgery, Hospital 12 de Octubre, 28041 Madrid, Spain.
Pediatric elbow fractures are quite common, accounting for up to 34% of bone fractures in children. Among these, acute lateral humeral condyle (LHC) fractures represent up to 22%. The accurate diagnosis and early treatment of LHC fractures are crucial due to the potential for abnormal growth and significant long-term impacts on joint motion.
View Article and Find Full Text PDFVet Radiol Ultrasound
January 2025
Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Roslin, UK.
Two skeletally immature female dogs were each investigated for chronic weight-bearing thoracic limb lameness. The first patient was lame for 2 months following a tumble whilst playing, and the second patient had been intermittently lame since 3 weeks of age. In both cases, radiographic examination of the shoulder revealed fissuring of the caudal humeral head consistent with an incomplete proximal humeral Salter-Harris type IV fracture with an Enoki-mushroom-like appearance of the caudal fragment, where two heads rise from a common stem.
View Article and Find Full Text PDFAm J Sports Med
January 2025
Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China.
Background: Studies have revealed abnormalities of the epiphyseal plate of the distal femur in patients with trochlear dysplasia, but it is unclear whether the epiphyseal plate could be remodeled after surgical correction of patellar dislocation.
Purpose: To investigate whether the morphology of the epiphyseal plate and trochlea could be improved after medial patellar retinaculum plasty in skeletally immature patients and to investigate the correlations between the morphology of the epiphyseal plate and trochlear dysplasia as well as clinical outcomes.
Study Design: Cohort study; Level of evidence, 3.
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