ORDER OF VERBAL EXAMS

Transcription

1 ORDER OF VERBAL EXAMS The students are able to register for the exam on the NEPTUN system. The students pick two titles, from the title list available at the beginning of the Semester. This list can be also found on the web site of the Orthopaedic Department. Those students who attended at least 70 % of the lectures will pick two titles, but will only be examined on the one of their choice. In case of a B or C exam the student is not entitled to the above advantage

2 Developmental dysplasia of the hip Pathology, diagnosis, conservative and surgical treatment University of Debrecen Department of Orthopaedic Surgery 2

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8 Diagnostic possibilities Physical examination X-ray Ultrasound dislocation (positive Ortolani test) unstable hip (positive Barlow test) contracture dislocation subluxation dysplasia dislocation subluxation dysplasia limping positive Trendelenburg test abreviation dislocation-reduction sign 8 at birth 1 month 4 month 1 year Age

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18 1. table: case distribution of 5620 newborn on the basis of hip type determined with ultrasound Type Case number Total Therapy Developed I/a I/b % Physiologically undeveloped II/a ,3 % Wide diapering, repeated examination Undeveloped, dysplastic and dislocated II/c D III/a IV ,7 % Pavlik harness Total % 18

19 Beginning of the treatment Ultrasound examination Hip type Total II/c D III/a IV Group with risk factor 4-6 weeks First weeks Repeated Group without risk factor weeks First Total

20 History Positive II/c D III/a IV Total Negative II/c D III/a IV Total Total Physical examination Positive abnormal Loose Stiff Unstable, click Negative Total

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25 1. SURGICAL REDUCTION OF DISLOCATED AND SUBLUXATED HIPS 25

26 INDICATION The operation is indicated up to 2 years of age, if concentric reduction was not possible by conservative 26 treatment.

27 MAIN POINTS OF OUR SURGICAL METHOD 1. When surgery is indicated, it should be undertaken at the earliest possible age (practically 6-7 months) 2. Complete exposure of the joint capsule using anterior approach. Psoas tendon is detached from it s insertion. 3. Opening the capsule and excision of all obstacles of reduction from the acetabulum. 27

28 4. Tight closure of the capsule preventing redislocation of the hip. Psoas tendon sutured to the femoral neck anteriorly. 5. Abandoning rigid postoperative plaster fixation. Further treatment by application of Pavlik harness or abduction splints. 6. Persistent acetabular dysplasia and/or femoral anteversion are corrected (if necessary!) only later, at 28 least after one year.

29 29 M. E. 21 é DE OEC

30 30 P. A. 17 é DE OEC

31 4. Tight closure of the capsule preventing redislocation of the hip. Psoas tendon sutured to the femoral neck anteriorly. 5. Abandoning rigid postoperative plaster fixation. Further treatment by application of Pavlik harness or abduction splints. 6. Persistent acetabular dysplasia and/or femoral anteversion are corrected (if necessary!) only later, at 31 least after one year.

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35 35 P. K. 7 é ill. 22 é DE OEC

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39 3. SURGICAL POSSIBILITIES IN THE TREATMENT FOR AVASCULAR NECROSIS OF THE HIP (ISCHAEMIA) IATROGENIC DAMAGE! 39

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