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VOLUME 2 , ISSUE 2-3 ( December, 2007 ) > List of Articles

Original Article

Peri-acetabular external fixation for hip disease: an anatomical study

Shaun Brown, Irwin Lasrado, Leo Donnan

Keywords : External fixation, Hip distraction, Anatomy

Citation Information : Brown S, Lasrado I, Donnan L. Peri-acetabular external fixation for hip disease: an anatomical study. 2007; 2 (2-3):69-75.

DOI: 10.1007/s11751-007-0019-3

License: CC BY-NC-SA 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2007; The Author(s).


Abstract

Hip distraction using cross joint articulated external fixation has been used by a number of orthopaedic centres for the treatment of osteoarthritis, chrondrolysis, and osteonecrosis, as an alternative to hip arthroplasty or arthrodesis in the adolescent and young adults. The hip, however, is problematic with respect to external fixation, as it lies deep, surrounded by powerful muscles and in intimate contact with major neurovascular structures and intrapelvic organs. The numbers of patients treated by this technique to date remains small and the technical detail and potential complications, with respect to the application of the external fixation, unclear. In this study we used anatomical information from CT scans combined with computer modelling of the hip and pelvis to identify safe screw positions in the periacetabular region. The surgical insertion of the pins was then performed on five cadavers and anatomical dissections undertaken to confirm the structures at risk. This study indicated that whilst there are a number of anatomic constraints, it is still possible to insert three pins with good divergence into the limited bony corridor of the peri-acetabular region recognising that the more posterior of the laterally inserted pins poses a potential risk to the sciatic nerve if not inclined away from the sciatic notch.


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  1. Routt M, Nork S, Mills W (2000) Percutaneous fixation of pelvic ring disruptions. Clin Orthop 375:15-29
  2. Scher D, Jeong G, Grant A, Lehman W, Feldman D (2001) Hip Arthodesis in adolescents using external fixation. J Pediatr Orthop 21:194-197
  3. Aldegheri R, Trivella G, Saleh M (1994) Articulated distraction of the hip. conservative surgery for arthritis in young patients. Clin Orthop 301:94-101
  4. Canadell J, Gonzales F, Barrios R, Amillo S (1993) Arthrodiastasis for stiff hips in young patients. Int Orthop 17:254-258
  5. Kucukkaya M, Kabukcuoglu Y, Ozturk I, Kuzgun U (2000) Avascular necrosis of the femoral head in childhood: the results of treament with articulated distraction method. J Pediatr Orthop 20:722-728
  6. Maxwell S, Lappin K, Kealey W, McDowell B, Cosgrove A (2003) Arthrodiastasis in Perthes' disease. J Bone Joint Surg Br 86:244-250
  7. Kocaoglu M, Kilicoglu O, Goksan S, Cakmak M (1999) Ilizarov Fixator for the treatment of Legg-Calve-Perthes disease. J Pediatr Orthop 8:276-281
  8. Salter R, Simmons D, Malcolm B, Rumble E, MacMichael D, Clements N (1980) The biological effect of continuous passive motion on the healing of full thickness defects in articular cartilage. J Bone Joint Surg Am 62:1232-1251
  9. Aldegheri R, Trivella G, Saleh M (2000) Articulated distraction of the hip. In: de Bastiani G, Apley G, Goldberg A (eds) Orthofix external fixation in trauma and orthopaedics. Springer, London, pp 605-612
  10. Kim W, Hearn T, Seleen O, Mahalingam E, Stephen D, Tile M (1999) Effect of pin location on stability of pelvic external fixation. Clin Orthop 361:237-44
  11. Haidukewych G, Kumar S, Prpa B (2003) Placement of half-pins for supra-acetabular external fixation: an anatomic study. Clin Orthop 411:269-273
  12. Noordeen M, Taylor B, Briggs T, Lavy C (1993) Pin placement in pelvic external fixation. Injury 24:581-584
  13. Ilizarov G (1992) In: Ilizarov GA (ed) Transosseous oseosythnesis. Springer, New York
  14. Thacker M, Feldman D, Madan S, Straight J, Scher D (2005) Hinged distraction of the adolescent arthritic hip. J Pediatr Orthop 25:178-182
  15. Grothaus M, Holt M, Mekhail A, Ebraheim N, Yeasting R (2005) Lateral femoral cutaneous nerve: an anatomic study. Clin Orthop 437:164-168
  16. de Ridder V, de Lange L, Popta J (1999) Anatomical variations of the lateral femoral cutaneous nerve and the consequences for surgery. J Orthop Trauma 13:207-211
  17. Hospodar P, Ashman E, Traub J (1999) Anatomic study of the lateral femoral cutaneous nerve with respect to the ilioinginal surgical dissection. J Orthop Trauma 13:17-19
  18. Bos J, Stoeckart R, Klooswijk A, van Linge B, Bahadoer R (1994) The surgical anatomy of the superior gluteal nerve and anatomical radiologic basis of the direct lateral approach to the hip. Surg Radiol Anat 16:253-258
  19. Jacobs L, Buxton R (1989) The course of the superior gluteal nerve in the lateral approach to the hip. J Bone Joint Surg Am 71:1239-1243
  20. Johnson W, Fischer D (1983) Skeletal stabilization with a multiplane external fixation device. Biomechanical evaluation and finite element model. Clin Orthop 180:34-43
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