professor, orthopaedics rutgers-new jersey medical schoolllrs.org/pdfs/specialty day...
TRANSCRIPT
![Page 1: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/1.jpg)
Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics
Rutgers-New Jersey Medical School
![Page 2: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/2.jpg)
My disclosure is in the Final Program and in the AAOS Orthopaedic Disclosure
Program.
I have no conflicts.
![Page 3: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/3.jpg)
![Page 4: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/4.jpg)
•Severe SCFE = worse prognosis
•Altered biomechanics
•Femoro-Acetabular impingement
•Various realignment strategies
•Percutaneous Osteotomy / Ilizarov
![Page 5: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/5.jpg)
Modified Southwick osteotomy Half-pins in proximal / distal fragments Femoral arches orthogonal to each fragment Percutaneous multiple-drill hole osteotomy Triplanar correction Reposition arches parallel to each other Connect arches with threaded rods Fine tune with conical washers
![Page 6: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/6.jpg)
1.8 mm wire Femoral Arches 4.8 mm drill bit HA coated pins Osteotomes Threaded rods Conical washers
![Page 7: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/7.jpg)
Radiolucent table Supine Bump under buttock
![Page 8: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/8.jpg)
![Page 9: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/9.jpg)
![Page 10: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/10.jpg)
![Page 11: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/11.jpg)
![Page 12: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/12.jpg)
![Page 13: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/13.jpg)
![Page 14: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/14.jpg)
![Page 15: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/15.jpg)
Orthogonal Femoral Arches
![Page 16: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/16.jpg)
![Page 17: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/17.jpg)
Frontal view
![Page 18: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/18.jpg)
![Page 19: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/19.jpg)
Percutaneous multiple drill hole osteotomy with correction
![Page 20: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/20.jpg)
1. Internal Rotation 2. Anterolateral Translation 3. Flexion and Abduction
![Page 21: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/21.jpg)
![Page 22: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/22.jpg)
![Page 23: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/23.jpg)
Threaded rods / Conical washers Both arches almost parallel
![Page 24: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/24.jpg)
![Page 25: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/25.jpg)
![Page 26: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/26.jpg)
![Page 27: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/27.jpg)
![Page 28: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/28.jpg)
![Page 29: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/29.jpg)
• Follow up: 23 (6 – 49) months
• Time in OR: 143 (118 – 210) mins
• Blood loss: 61 (50 – 100) cc
• Hospital stay: 2.4 (2 -4) days
• Time in fixator: 18 (14 – 23) weeks
![Page 30: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/30.jpg)
Results: Range of Motion
ROM (deg) Pre-op Post-op Diff p value
Flexion 74 106 33 0.02 (20 – 90) (95 – 130)
IR -5 17 24 0.007
(-33 – 15) (5 – 40)
ER 71 41 29 0.0003
(25 – 90) (5 – 68)
Abduction 29 36 12 0.23
(14 – 50) (25 – 45)
![Page 31: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/31.jpg)
Results: Radiographic
Pre-op Post-op Diff p value
AP Head Shaft 112 134 22 0.004 Angle (deg) (84 – 138) (117 – 154)
Lat Head Shaft 72 15 57 <0.0001
Angle (deg) (57 – 101) (-2 – 26)
LLD (cm) 1.8 1.8 1.2 0.80
(0.6 – 2.9) (0 - 4)
![Page 32: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/32.jpg)
Postop Scanogram
![Page 33: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/33.jpg)
Before osteotomy
After removing external fixator
![Page 34: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/34.jpg)
![Page 35: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/35.jpg)
Transient chondrolysis 1 Fixation related problems 0 Deep infection 0 AVN 0 Refracture 0 Unplanned OR 0
![Page 36: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/36.jpg)
Langenskiold
Pauwels
Borden
![Page 37: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/37.jpg)
![Page 38: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/38.jpg)
![Page 39: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/39.jpg)
![Page 40: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/40.jpg)
![Page 41: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/41.jpg)
![Page 42: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/42.jpg)
0
20
40
60
80
100
120
140
Preop Post op Final F/u
74°Pre op 33°Post op (∆=41°)
![Page 43: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/43.jpg)
0
20
40
60
80
100
120
140
160
Preop Post op Final F/u
86°Pre op 137°Post op (∆=51°)
![Page 44: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/44.jpg)
-20
-15
-10
-5
0
5
10
15
20
25
30
Preop Post op Final F/u
- 6 mm Pre op + 11mm Post op (∆=17 mm)
![Page 45: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/45.jpg)
![Page 46: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/46.jpg)
Safe Effective in large patients Accurate / sustained correction Minimize blood loss Avoids further shortening May do lengthening as needed Early mobilization
![Page 47: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/47.jpg)
Need to be familiar with ex fix Time in fixator Pin related issues Impact on future surgery ? Short follow up
![Page 48: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/48.jpg)
Percutaneous technique appears safe and effective in correcting pediatric proximal femoral deformities associated with: SCFE
Developmental Coxa Vara
Painful Dislocated Hips in CP
![Page 49: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/49.jpg)
My disclosure is in the Final Program and in the AAOS Orthopaedic Disclosure
Program.
I have no conflicts
![Page 50: Professor, Orthopaedics Rutgers-New Jersey Medical Schoolllrs.org/PDFs/Specialty Day Presentations/3_14_Specialty... · 2017-10-19 · Sanjeev Sabharwal, MD, MPH Professor, Orthopaedics](https://reader034.vdocuments.mx/reader034/viewer/2022042410/5f285a53f077591830257c76/html5/thumbnails/50.jpg)
My disclosure is in the Final Program and in the AAOS Orthopaedic Disclosure
program.
My disclosure is: