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World J Orthop. Sep 18, 2014; 5(4): 412-424
Published online Sep 18, 2014. doi: 10.5312/wjo.v5.i4.412
Figure 4
Figure 4 Different types of femoral reconstruction options. A: Wagner’s apparatus for preoperative skeletal traction to reduce high congenital dislocation of the hip before total hip arthroplasty; B: Trochanteric osteotomy in total hip arthroplasty; C: Delimar et al[7] modification of the direct lateral approach to the hip. Anterior half of the continuous tendon is detached either by cautery or with a chisel. If the chisel is used, a thin layer of bone from the greater trochanter remains attached to the continuous tendon of the gluteus medius and the vastus lateralis. The posterior half of the continuous tendon of the gluteus medius and the vastus lateralis is always detached with the chisel leaving a bone flake of at least 2 to 3 mm thickness attached to tendons. In that way, the abductor muscles are stripped from the greater trochanter and there is no trochanteric osteotomy during the approach, which allows preservation of the continuity of the abductor muscles; D: Paavilainen's procedure of metaphyseal shortening osteotomy combined with distal sliding of the greater trochanter with intact attachment of the abductor muscles; E: Progressive femoral shortening at the level of lesser trochanter; greater trochanter remains intact, thus providing better functional results; F: Combined procedure of femoral subtrochanteric shortening with derotational double-chevron osteotomy. Transverse osteotomy was first performed, followed by rotational alignment in order to correct anteversion. Later, double chevron osteotomy was performed. Such method allows intraoperative derotation and shortening adjustment; G: Subtrochanteric osteotomy - modified technique; osteotomy sites were covered with onlay grafts of the excised fragments and fixed with two cerclage wires; H: Diaphyseal step-cut shortening osteotomy performed after reaming and stabilized with two to three cerclage bands with or without bone grafting. After stabile fixation, intramedullary reaming is done until optimal cortical contact is achieved, especially distal to the osteotomy site; I: Distal femur shortening procedure. First, total hip arthroplasty with acetabulum in anatomic position is performed followed by the femoral shortening that is done distal to stem so that the first screw of the plate would be more than 2 cm from the stem. Later, plate fixation of the femoral osteotomy site was performed.