Ilizarov pelvic support osteotomy in a case of post-infective pathological fracture-dislocation of hip

Abstract

Abstract Various pelvic support osteotomies provide improved hip stability. Unequal limb length remains a major disability. Ilizarov hip reconstruction procedure could additionally correct excessive distal limb valgus, inequality of limb length, and flexion contracture of the hip. This procedure is applied to the present case to note the short-term result. A 16-year-old girl presented 9 years after the initial infection with the sequel of septic arthritis of the right hip. She had frequent pain over her groyne and a significant Trendelenburg gait. Scanogram showed 5 cm proximal femoral migration, but 4 cm shortening at knee level. A 10° flexion contracture with a significant reduction of all movement, except adduction, is noted. After preoperative planning and confirming under C-arm image proximally femur is osteotomized at the level of ischium to achieve 50° abduction (40° maximum abduction + 10° over correction) and fixed using 6 mm Schanz pins. The distal ring is connected to the middle ring by a motor on the lateral and hinges on the medial aspect. Distraction starts on the 3rd day to obtain 10° varus and 2 cm lengthening, which aligns knees at the same level and equidistance from the midline. Osteotomies are united in 4 months and the frame is removed after 5 months. The length is equalised, correction of Trendelenburg gait, exaggerated lumbar lordosis and pain-free groyne. Available pain-free movements are as that of the preoperative stage except for adduction. Harris hip score improved from 49.2 to 94. Ilizarov hip reconstruction procedure improves Trendelenburg gait, equalises limb length discrepancy, alleviates groyne pain, and corrects pelvic tilt.