Transposition of the great trochanter: A look at the problem

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BACKGROUND: Multiplanar deformity of the proximal femur with a high position of the greater trochanter is one of the most common residual deformities of the hip joint. The Veau–Lamy transposition of the greater trochanter does not fully treat the mutual trauma of the components of the hip joint, as it only brings down the greater trochanter to provide tension for the gluteal muscles.

AIM: This study aimed to share the experience of performing transposition of the greater trochanter according to our proposed technique.

MATERIALS AND METHODS: The study included 15 patients (15 hip joints) aged 9–16 years with a high position of the greater trochanter of the femur, who underwent surgical treatment in the period from 2018 to 2019. In addition to the actual transposition of the greater trochanter, the intervention provided a modeling resection of the base (bed) of the greater trochanter and the formation of an offset of the femoral neck.

RESULTS: Patients were followed up for period of up to 30 months. All patients showed positive changes after surgical treatment with improvement of radiological and clinical parameters.

CONCLUSIONS: The proposed intervention allows restoration of the function of the gluteal muscles, improves the range of motion in the hip joint, and prevents and treats extra-articular impingement syndrome.

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作者简介

Ivan Pozdnikin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

编辑信件的主要联系方式.
Email: pozdnikin@gmail.com
ORCID iD: 0000-0002-7026-1586
SPIN 代码: 3744-8613

MD, PhD

俄罗斯联邦, Saint Petersburg

Pavel Bortulev

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: pavel.bortulev@yandex.ru
ORCID iD: 0000-0003-4931-2817
SPIN 代码: 9903-6861

MD, PhD

俄罗斯联邦, Saint Petersburg

Dmitry Barsukov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: dbbarsukov@gmail.com
ORCID iD: 0000-0002-9084-5634
SPIN 代码: 2454-6548

MD, PhD

俄罗斯联邦, Saint Petersburg

Vladimir Baskov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: drbaskov@mail.ru
ORCID iD: 0000-0003-0647-412X
SPIN 代码: 1071-4570

MD, PhD

俄罗斯联邦, Saint Petersburg

参考

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  3. Pozdnikin IJu, Baskov VE, Barsukov DB, et al. Gipertrofija bol’shogo vertela i vertel’no-tazovyj impindzhment-sindrom u detej (prichiny formirovanija, rentgenoanatomicheskaja harakteristika). Ortopedija, travmatologija i vosstanovitel’naja hirurgija detskogo vozrasta. 2019;7(3):15–24. (In Russ.). doi: 10.17816/PTORS7315-24
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  13. Patent RF No. 2734054 RF, MPK A61V 17/76/ 12.10.2020, Bjul. No. 29. Pozdnikin IJu, Barsukov DB, Bortuljov PI. Sposob hirurgicheskogo lechenija detej s vysokim polozheniem bol’shogo vertela. (In Russ.) [cited 2021 Apr 6]. Available from: https://patenton.ru/patent/RU2734054C1
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2. Fig. 1. Scheme of the transposition of the greater trochanter according to the proposed technique. A reconstructed hip joint model of a patient with a high greater trochanter is presented. a, diagram of the hip joint (front view). b, proximal femur (posterior view). c, proximal femur (top view). d, proximal femur after surgery according to the proposed method (frontal view). 1, femoral head. 2, greater trochanter. 3, lesser trochanter. 4, line of osteotomy of the greater trochanter. 5, line of modeling resection of the neck, base of the greater trochanter, and resection of the lesser trochanter. 6, line of modeling resection of the neck and base of the greater trochanter in front. 7, cortical screws fixing the greater trochanter

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3. Fig. 2. X-ray images of patient K. (10 years old). Congenital subluxation of the left hip after a conservative treatment; consequences of aseptic necrosis of the proximal femur and the high position of the greater trochanter. a, b, before surgical treatment. c, immediately after the surgery (transposition of the greater trochanter, simulating the resection of the left femoral neck and lesser trochanter). d, e, 2 years after the surgery

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