[Distal transfer of the greater trochanter among other surgical procedures for the treatment of hip deformity]. / Obnizenie kretarza wiekszego wsród innych metod leczenia operacyjnego deformacji biodra.

Distal greater trochanteric transfer is a rarely used procedure for treatment of hip deformity. Surgical technique is described. Potential for changing morphology of proximal end of the femur is underlined and pitfalls indicated. The main advantage of the procedure is reconstruction of the femoral neck. It is biomechanically more sound than valgus osteotomy done frequently in similar cases. Advantages of trochanteric transfer are confirmed by other authors who after this procedure achieved clinical and radiological improvement in patients with degenerative disease of the hip.

The value of distal greater trochanteric transfer in the treatment of deformity of the proximal femur owing to avascular necrosis.

A series of 49 patients (55 hips) who had distal greater trochanteric transfer at the mean age of 13.9 years because of the deformity of the proximal femur after treatment for developmental dislocation of the hip was reviewed to verify the value of the procedure. Mean follow-up was 8.8 years. Clinical and radiologic assessment was supplemented with strain-gauging evaluation of the muscles involved. Good results were achieved in patients who had good range of movement or isolated restriction of abduction before the operation. After surgery, a 22% increase of abductors torque was found, the Trendelenburg sign disappeared in 30 individuals, and 15 patients regained normal gait. No complications were observed. Our study confirmed the value of distal transfer of the greater trochanter in treatment for proximal femur deformity owing to avascular necrosis after management of developmental dislocation of the hip and clarified indications for this procedure.

[Greater trochanter epiphyseodesis in treatment of hip deformity]. / Epifizjodeza kretarza wiekszego w leczeniu deformacji biodra.

A series of 29 patients (33 hips) after greater trochanter epiphyseodesis in treatment for hip deformity has been reviewed. An indication for this surgery was increasing proximal femur deformity due to the damage of subcapital growth plate (avascular necrosis) during the treatment for congenital dysplasia of the hip. The age of patients at surgery was mean 8.1 years, mean follow-up was 10.1 year. Clinical and radiological assessment revealed ineffectiveness of greater trochanter epiphyseodesis in treatment for increasing hip deformity due to avascular necrosis in the age group in question.

[Oblique subtrochanteric osteotomy in treatment of leg length inequality]. / Skosna osteotomia podkretarzowa w leczeniu nierównej dlugosci konczyn dolnych.

Pros and cons of different modes of leg length discrepancy management are briefly discussed. Results of surgical treatment of 35 patients have been analysed. The most frequently employed technique has been presented in details. Its simplicity, fast bony union, few complication and possibility to avoid additional immobilisation make this method a valuable alternative for lower extremities equalization.

Paralytic drop foot and gluteal fibrosis after intramuscular injections.

Eight children with paralytic drop foot after intramuscular injections later developed gluteal fibrosis. Sciatic palsy, presenting as equinovarus or equinus deformity, was diagnosed on average 3.8 months after the intragluteal injections, but gluteal fibrosis was not diagnosed until 5.1 years after the injections. In three patients the equinovarus recurred after surgical correction due to persistent muscle imbalance and the effect of the external rotation contracture of the hip.

[Coexistent paralytic drop foot and gluteal fibrosis after intramuscular infections--therapeutic implications]. / Wspólistnienie stopy konskiej porazennej i zwlóknienia miesni posladkowych po iniekcjach domiesniowych--implikacje terapeutcyzne.

Six children with paralytic drop foot, which developed after intramuscular injections and who had co-existing gluteal fibrosis are presented in this study. Paralytic drop foot was diagnosed on an average of 5.5 months after intra-gluteal injections. This was the major therapeutic problem. The diagnosis of gluteal fibrosis was made on an average only 3 years and 7 months later. In 3 cases the external rotation and abduction contracture of the extremity in the hip joint, caused by gluteal fibrosis, with active plantar flexors and supinators of the foot could contribute to the recurrence of the equinovarus deformity of the surgically corrected foot.