Hip reduction surgery versus scoliosis correction in non-ambulant neuromuscular patients: which surgery is the first step?

PURPOSE: Children and young adults with neuromuscular disorders have a high incidence of both spine and hip deformities. The aim of this study was to evaluate the outcome of either primary scoliosis or hip surgery in children and young adults with neuromuscular disorders. METHODS: A retrospective study was conducted on all children and young adults with neuromuscular-related synchronous hip subluxation/dislocation and scoliosis undergoing hip or scoliosis surgery in our institution between 2012 and 2021 with a minimum follow-up of 24 months. Demographic and operative data were collected; radiological parameters were measured preoperatively and postoperatively at final follow-up. RESULTS: Forty neuromuscular patients with synchronous hip displacement and scoliosis were included. Twenty patients with an average age of10.2 years had hip correction surgery performed primarily, with a mean follow-up of 54.9 (24-96) months. The other 20 patients with an average age of 12.4 years had scoliosis correction first, with a mean follow-up of 40 (24-60) months. In the "Hip first" group, pelvic obliquity, hip MP and Cobb angle were 16.8°, 71%, and 49°, respectively. At final follow-up, the mean pelvic obliquity and Cobb angles significantly progressed to 27.2° (p = 0.003) and 82.2° (p = 0.001), respectively. Eighteen patients (90%) required scoliosis correction after the hip surgery. In the "Scoliosis first" group, the mean pelvic obliquity, hip MP and Cobb angle were 21.2°, 49% and 65.5°, respectively. At final follow-up, both pelvic obliquity and Cobb angle significantly improved to 8.44° (p = 0.002) and 23.4° (p = 0.001), respectively. In 11/20 (55%) patients, the hip MP had significantly increased following the spinal surgery to 62% (p = 0.001), but only 5/20 (25%) patients underwent hip surgery after scoliosis correction. CONCLUSION: In neuromuscular patients presenting with synchronous hip displacement and scoliosis deformity, corrective scoliosis surgery is associated with a significant correction of pelvic obliquity and lower rates of secondary hip surgery. On the other hand, primary hip surgery does not reduce the risk of pelvic obliquity and scoliosis deformity progression.

Cerclaje con alambre en fracturas subtrocantéricas de cadera. Análisis de beneficios y complicaciones / Cerclage wiring in subtrochanteric hip fractures. Analysis of benefits and complications

Introducción: El objetivo de este estudio retrospectivo fue evaluar si la reducción abierta con cerclaje de alambre afectó la consolidación, la tasa de complicaciones y de reoperaciones en pacientes con fracturas subtrocantéricas de cadera, tratadas con clavos cefalomedulares. materiales y métodos:Se evaluó a todos los pacientes operados consecutivamente entre enero de 2010 y diciembre de 2017. Se comparó a los tratados con cerclaje (Grupo A) o sin cerclaje (Grupo B) de alambre en términos de tipo de fractura, estancia hospitalaria, tiempo quirúrgico, necesidad de transfusiones, calidad de la reducción, consolidación y complicaciones (infección, seudoartrosis, reoperaciones). Resultados:Se incluyó a 58 pacientes. El grupo A estaba conformado por 20 pacientes y el grupo B, por 38. El tipo de fractura más frecuente fue 3A (p = 0,0004). La estancia hospitalaria fue similar (9.0 vs. 10.6 días; p = 0,81), el tiempo quirúrgico y la necesidad de transfusiones fue mayor en el grupo A (p<0,0001 y p = 0,58, respectivamente). La tasa de consolidación fue similar en ambos grupos (90 vs. 92,1%, respectivamente; p = 0,09). Los desejes se observaron solo en el grupo tratado sin lazadas (5-13,5%; p = 0,01). Las tasas de complicaciones (15 vs. 18,4%) y de reopera-ciones (15 vs. 15,8%) fueron similares (p = 0,99). Conclusiones: El uso de lazadas de alambre en fracturas subtrocantéricas de cadera tratadas con clavos cefalomedulares generó un aumento significativo del tiempo quirúrgico, y disminuyó significativamente la incidencia de desejes. La incidencia de reoperaciones fue menor, aunque no significativamente. Nivel de Evidencia: III

Background: The aim of this retrospective study was to assess whether open reduction with cerclage wire affected the union and/or complication rate in subtrochanteric hip fractures treated with cephalomedullary nails. materials and methods: We analyzed all patients who had undergone surgery in our center between January 2010 and December 2017. We comparatively analyzed those treated with (Group A) and without (Group B) cerclage wire in terms of fracture type, hospital stay, surgical time, blood transfusions, malalignment, union, and complications (infection rates, non-union, and reoperations). Results: Fifty-eight patients were included. Group A consisted of 20 patients and Group B of 38. The most frequent type of fracture was 3A (p 0.0004). The mean hospital stay was similar (9 vs 10.6 days p 0.81), the surgical time and transfusions were higher in group A (p<0.0001 and p 0.58 respectively). The union rate was similar (90 vs 92.1%; p 0.09, respectively). Malalignment was only observed in group B (5 - 13.5%; p 0.01). The complication (15 vs 18.4%) and reoperation (15 vs 15.8%) rates were similar (p 0.99). Conclusions: The use of cerclage wire in subtrochanteric hip fractures treated with cephalomedullary nails generated a significant increase in surgical time and a lower rate of malalignment. It allowed a lower rate of re-operation, although it was not significant. Level of Evidence: III