Avascular necrosis of the femoral head in childhood: the results of treatment with articulated distraction method

The treatment of avascular necrosis of the femoral head in children is still being debated. We performed articulated distraction in 11 children with avascular necrosis of the femoral head between March 1994 and February 1997. The reasons for avascular necrosis were: Perthes disease in eight patients, fracture of the femoral neck in two, and complication arising because of treatment of developmental hip dysplasia in one. Mean age was 7.9 years. Fixator duration time was 3.5 months and mean follow-up was 32 months. At follow-up, the femoral head was spherical and congruent in four patients, aspherical and congruent in five, and aspherical and incongruent in two according to Stulberg's criteria. The aim of the articulated distraction method is to neutralize muscle and weight-bearing forces, to prevent stress fractures of subchondral immature bone, to encourage synovial circulation, and to promote creeping substitution.

The ANK device: a new approach in the treatment of the fractures of the lateral malleolus associated with the rupture of the syndesmosis

The ANK device was developed for the treatment of fractures of the lateral malleolus occurring with rupture of the syndesmosis. While it provides the anatomic reduction of the fracture and the syndesmosis, it allows the physiologic movements of the fibula. It is not used for comminuted fractures of the lateral malleolus and in cases where fibular medullary canal is narrow. We included forty-nine patients who had the ANK device applied and at least 2 years follow-up. The mean follow-up was 41 months (range 24-124). The fractures were evaluated according to the Lauge-Hansen classification; 25 cases were evaluated as supination-external rotation, 11 cases were pronation-abduction, and 13 cases were pronation-external rotation type fractures. There were also 46 fractures of the medial malleolus and three ruptures of the deltoid ligament. Twenty-nine (59,2%) patients were evaluated as excellent, 12 (24,5%) as good, 5 (10.2%) as fair and 3 (6.1%) as poor. Arthrosis was observed in 3 (6.1%) of the patients.