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Pisecky L, Großbötzl G, Gahleitner M, Stevoska S, Stadler C, Haas C, Gotterbarm T, Klotz MC. Progressive lateralization and constant hip geometry in children with DDH, NDH, and LCPD following hip reconstructive surgery: a cohort study of 73 patients with a mean follow-up of 4.9 years. Arch Orthop Trauma Surg 2023; 143:1193-1202. [PMID: 34687350 PMCID: PMC9958182 DOI: 10.1007/s00402-021-04227-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/13/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Pelvic and femoral osteotomies have been effective methods to treat developmental dysplasia of the hip (DDH), neurogenic dislocation of the hip (NDH), and Legg-Calvé-Perthes disease (LCPD). The aim of this study was to evaluate the mid-term results after hip reconstruction in children with DDH, NDH, and LCPD. METHODS In a retrospective study, X-rays of 73 children (2-19 years) with DDH, NDH, and LCPD were measured before, 3 months, and at final follow-up (FU) after hip reconstructive surgery (open reduction, and femoral and/or pelvic osteotomy ± soft-tissue procedures between 2008 and 2018). Measurement of hip geometry included acetabular index (AI), center-edge angle (CE), and Reimers migration index (RMI). Mean follow-up time at final FU was 4.9 years. P value was set P < 0.05. RESULTS After surgery (femoral osteotomy: 84 hips, Salter innominate osteotomy: 21 hips, Pemberton osteotomy: 30 hips, open reduction: 28 hips, Chiari osteotomy: 4 hips, and soft-tissue release: 24 hips), hip geometry parameters improved significantly. Nevertheless, at final FU, there was deterioration in hip geometry with femoral head lateralization (RMI) compared to the data at 3 months after surgery (RMI: preop/3 months/final FU: 40.6 ± 16.1%/6.1 ± 9.0/15.4 ± 16.0%; CE: 11.3° ± 20.0°/30.2° ± 9.5°/27.9 ± 15.4°; AI: 28.8° ± 9.6°/19.1° ± 7.6°/18.3 ± 7.6°). Sub-group analysis did not show differences concerning the progression of RMI in DDH, NDH, and LCPD at final FU. Regardless of basic disease, the lateralization was observed in all three groups (DDH, NDH, and LCPD) and statistically significant comparing X-rays 3 months postoperatively to maximum follow-up (DDH; NDH; LCPD: 2.7 ± 6.8%/7.6 ± 10.1%; 13.7 ± 15.3%/22.8 ± 19.8%; 1.7 ± 4.1%/14.9 ± 11.3%). Additional soft-tissue release techniques in patients with DDH or NDH did not show postoperative differences with statistical significance. Concerning surgical techniques, a connection between the lower RMI and the procedure of osteotomy of the ilium was found. In 25 patients, (34%) complications were observed: superficial skin lesions in 8, deep skin lesions in 3, contraction of adductors in 3, subluxation in 2, dislocations of the cast in 2, osteonecrosis of the femoral head in 2 cases, reluxation in 1, infection of the implanted plate in 1, compliance problem in 1, delayed bone healing in 1, and contraction of knee flexors in 1 case. DISCUSSION The basic results of this study show a significant improvement of hip geometry at a follow-up of 4.9 years and prove findings of previously published literature. Moreover, the study was able to show a progression of RMI in all patient groups, which have undergone reconstructive surgery, despite basic hip geometry data (AI, CE angle) did not change. Those findings were independent from underlying pathology. Complications were counted in 34% of the patients and involved all known adverse events after hip reconstructive surgery. This makes clear why annual follow-up checks are needed not to miss the right indication for revision surgery. CLINICAL RELEVANCE Evidence level: Level IV, case series. TRIAL REGISTRATION This manuscript is part of a prospective randomized clinical trial, registered in the German Clinical Trials Register DRKS-ID: DRKS00016861.
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Affiliation(s)
- Lorenz Pisecky
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
| | - Gerhard Großbötzl
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Manuel Gahleitner
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Stella Stevoska
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Christian Stadler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Christina Haas
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Matthias C Klotz
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
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Pisecky L, Großbötzl G, Stevoska S, Klotz MCM, Haas C, Gotterbarm T, Luger M, Gahleitner M. Short Term Radiological Outcome of Combined Femoral and Ilium Osteotomy in Pelvic Reconstruction of the Child. Children (Basel) 2022; 9. [PMID: 35327813 DOI: 10.3390/children9030441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Reconstruction of the pelvic joint is a common way to address developmental dysplasia of the hip (DDH), as well as neurogenic dislocation of the hip (NDH) and Legg−Calvé−Perthes disease (LCPD) in children. The purpose of this study was to analyze the short-term radiologic outcome after hip reconstructive surgery either treated with sole osteotomy of the femur or in combination with iliac osteotomy in patients with DDH, NDH and LCPD. Materials and Methods: X-rays of 73 children, aged 2−18 years, with DDH, NDH and LCPD after hip reconstructive surgery were measured retrospectively and compared to the preoperative x-rays concerning various parameters to define hip geometry. The surgical procedures were femoral osteotomy (74), Salter innominate osteotomy (27), Pemberton osteotomy (27), open reduction (37), Chiari osteotomy (4). The pre-/postoperative acetabular index (AI), center-edge angle (CE) and Reimers migration index (RMI) were evaluated before and 3 months after surgery. Results: Hip geometry parameters improved significantly (RMI: preop/postop: 62.23% ± 31.63%/6.30% ± 11.51%, p < 0.001; CE: 11.53° ± 20.16°/30.58 ± 8.81°, p < 0.001; AI: 28.67° ± 9.2°/19.17 ± 7.65°, p < 0.001). Sub-group analysis showed a superior RMI in DDH compared with NDH 3 months after surgery (DDH/NDH: 2.77% ± 6.9%/12.94% ± 13.5%; p = 0.011). Osteotomy of the iliac bone (Salter innominate, Pemberton, Chiari) resulted in a significant improvement of the postoperative RMI compared to cases without osteotomy of the ilium (7.02 ± 11.1% vs. 16.85 ± 4.71%; p = 0.035). Conclusions: Femoral and pelvic osteotomies are effective to improve the radiological pelvic parameters in infants and adolescents with DDH, NDH and LCPD. In addition, the study found that the combination of femoral and pelvic osteotomy led to a better RMI than femoral osteotomy alone. Using the combined ilium and femoral osteotomy, it was possible to show the highest effect on correction of the hip geometry with respect to residual RMI.
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Merckaert SR, Zambelli PY, Edd SN, Daniele S, Brigitte J. Mid- and long-term outcome of Salter's, Pemberton's and Dega's osteotomy for treatment of developmental dysplasia of the hip: a systematic review and meta-analysis. Hip Int 2021; 31:444-455. [PMID: 32678678 DOI: 10.1177/1120700020942866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Early diagnosis and early treatment have become the gold standard for management of developmental dysplasia of the hip. Surgery is required in case of failed initial treatment. Innominate pelvic osteotomy of Salter (SIO), Pemberton's pericapsular osteotomy (PPO) and Dega's acetabuloplasty (DA) are among the most used procedures.We performed a systematic review and meta-analysis of the past 57 years in order to assess the mid- and long-term outcome of these techniques. METHODS Studies met inclusion criteria if they: (1) reported at least 5 cases treated by 1 of the abovementioned surgical techniques; (2) included children aged between 1 and 8 years; (3) surgical indication was late detected DDH or a failed initial treatment; (4) presented a minimal follow-up of 24 months; (5) reported the radiological score of Severin and/or the clinical score of McKay.Clinical and radiological outcomes were dichotomised into favourable and unfavourable outcome and weighted summary rates were determined using meta-analysis models. RESULTS From a total of 7391 articles, 48 level of evidence grade IV articles were included in our review. A total of 2143 cases with a mean follow up of 112.4 months were included.Pooled Severin score indicated a statistically better outcome for PPO and DA compared to SIO (p = 0.0003 and p = 0.002, respectively). By dichotomising the results in favourable and unfavourable outcome, PPO showed the best results (p = 0.0002 vs. SIO, p = 0.01 vs. DA).Pooled McKay score showed a statistically better outcome for PPO and DA compared to SIO (p < 0.0001 and p = 0.03, respectively) as well as better outcomes for PPO compared to DA (p = 0.01). By dichotomising the results in favourable and unfavourable, PPO showed the best results. CONCLUSIONS Even if our review demonstrates slightly better radiological and clinical results with the PPO, the currently available and limited data do not allow for clear recommendation towards one of these techniques.
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Affiliation(s)
- Sophie R Merckaert
- Department of Paediatric Orthopaedic Surgery, Children's Hospital, Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, Switzerland
| | - Pierre-Yves Zambelli
- Department of Paediatric Orthopaedic Surgery, Children's Hospital, Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, Switzerland
| | - Shannon N Edd
- Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland
| | - Starnoni Daniele
- Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Jolles Brigitte
- Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland.,Institute of Micro Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Schmidutz F, Roesner J, Niethammer TR, Paulus AC, Heimkes B, Weber P. Can Salter osteotomy correct late diagnosed hip dysplasia: A retrospective evaluation of 49 hips after 6.7 years? Orthop Traumatol Surg Res 2018; 104:637-643. [PMID: 29886151 DOI: 10.1016/j.otsr.2018.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/12/2018] [Accepted: 05/21/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Surgical treatment of late diagnosed development dysplasia of the hip (DDH) remains challenging with several methods being described. We therefore retrospectively evaluated the outcome of Salter innominate osteotomy (SIO) in patients with fully-grown bone, to evaluate whether this surgical procedure allows sufficient acetabular correction. MATERIAL AND METHODS Between 2004-2012 SIO had been performed in 45 patients (49 hips) with late diagnosed DDH. The evaluation included pre- and postoperative radiographs (n=49), the complication rate (n=49) and the clinical outcome (WOMAC, HHS, UCLA) (n=34). RESULTS Mean age at surgery was 27.6 (16-51) with a follow-up of 6.7±2.7 (0.9-11.0) years. Radiologically, a good acetabular correction with a significant improvement of the Center Edge angle (15.4° to 34.9°), sharps angle (45.7° to 32.0°) and migration percentage (33.2% to 14.4%) (p<0.001) was found. Clinical results revealed a WOMAC of 13.9±13.3, UCLA of 7.8±2.1 and HHS of 85.0±11.8. Complications were noted for 10 patients (20%) with 7 (14%) requiring revision. CONCLUSION The results demonstrated that SIO achieved a satisfying acetabular correction and good clinical results in late diagnosed DDH. It therefore might be an option in some cases, although periacetabular osteotomy techniques are currently preferable used as they allow a wider range of acetabular correction. LEVEL OF EVIDENCE IV, retrospective observational study.
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Affiliation(s)
- Florian Schmidutz
- University of Munich (LMU), Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Germany; University of Tübingen, BG Trauma Center Tübingen, Germany.
| | - Johannes Roesner
- University of Munich (LMU), Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Germany
| | - Thomas R Niethammer
- University of Munich (LMU), Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Germany
| | - Alexander C Paulus
- University of Munich (LMU), Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Germany
| | - Bernhard Heimkes
- University of Munich (LMU), Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Germany
| | - Patrick Weber
- University of Munich (LMU), Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Germany
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Tsukagoshi Y, Kamegaya M, Kamada H, Saisu T, Morita M, Kakizaki J, Tomaru Y, Yamazaki M. The correlation between Salter's criteria for avascular necrosis of the femoral head and Kalamchi's prognostic classification following the treatment of developmental dysplasia of the hip. Bone Joint J 2017; 99-B:1115-1120. [PMID: 28768791 DOI: 10.1302/0301-620x.99b8.bjj-2016-1070.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/18/2017] [Indexed: 12/31/2022]
Abstract
AIMS The aim of this study was to evaluate the correlation between Salter's criteria and Kalamchi's classification of avascular necrosis in patients treated for developmental dysphasia of the hip (DDH). PATIENTS AND METHODS The study involved a retrospective analysis of 123 patients (123 hips) with DDH treated by operative and non-operative reduction before the age of two years, with a minimum follow-up of ten years. Salter's criteria (S1 to S4) were determined from radiographs obtained at one to two years post-reduction, whilst the Kalamchi grade was determined from radiographs obtained at ten or more years of age. Early post-reduction radiographs were also used to evaluate the centre-head distance discrepancy (CHDD) and the occurrence of a dome-shaped deformity of the proximal femoral metaphysis (D-shaped metaphysis). The prognosis was described as good (Kalamchi grade K0 or KI), fair (Kalamchi grade KII) or poor (Kalamchi grade KIII or KIV) for analysis and correlation with the early Salter criteria, CHDD and D-shaped metaphysis. RESULTS S1 and S2 criteria were predictive of a poor prognosis. The outcome following S3, S4 and S3 + S4 varied; 18 (40%) had a good prognosis, 17 (38%) a fair prognosis and ten (22%) a poor prognosis. A CHDD ≥ 10% and a D-shaped metaphysis were also predictive of a poor prognosis. CONCLUSION The Salter criteria were predictive of the Kalamchi grade of avascular necrosis in patients with DDH aged ten or more years after reduction of the hip. Cite this article: Bone Joint J 2017;99-B:1115-20.
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Affiliation(s)
- Y Tsukagoshi
- University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - M Kamegaya
- Chiba Child & Adult Orthopaedic Clinic (Chiba Pediatric Orthopaedic Group), 3-24-2, Oyumino-Minami, Midori-ku, Chiba-city, Chiba, 266-0033, Japan
| | - H Kamada
- University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - T Saisu
- Chiba Children's Hospital (Chiba Pediatric Orthopaedic Group), 579-1, Heta-cho, Midori-ku, Chiba-city, Chiba, 266-0077, Japan
| | - M Morita
- Chiba Child & Adult Orthopaedic Clinic (Chiba Pediatric Orthopaedic Group), 3-24-2, Oyumino-Minami, Midori-ku, Chiba-city, Chiba, 266-0033, Japan
| | - J Kakizaki
- Chiba Children's Hospital (Chiba Pediatric Orthopaedic Group), 579-1, Heta-cho, Midori-ku, Chiba-city, Chiba, 266-0077, Japan
| | - Y Tomaru
- University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - M Yamazaki
- University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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Valles-Mata EM, Valles-Flores LA, Montes-Del Bosque RF. [Results of the Salters osteotomy as a definitive treatment for the developmental dysplasia of the hip]. Acta Ortop Mex 2016; 30:231-235. [PMID: 28448705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Evaluate the results of open reduction associated to a Salter osteotomy at nine months of age for treatment of the developmental Dysplasia of the Hip. MATERIAL AND METHODS Case- series of unilateral Developmental Dysplasia of the hip treated between July 2004- December 2008 with follow-up at 3, 6 and 9 months postop. RESULTS 16 patients, 13 females (81%) 3 males (19%). we did an open reduction and Salters osteotomy at 9 months on average (8- 10 months); the most effected side were the left hip on 75%. at 9 months of follow up 15 patients had a McKay score excellent and 1 good. Only one patient was followed up at one year with no pain, full range of motion and stable. CONCLUSION open reduction and salter osteotomy without preoperative traction is an effective treatment in the short-term; the range of motion could be affected. It is important that the spica cast were applied in a staged manner and in secured position.
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Affiliation(s)
- E M Valles-Mata
- Servicio de Ortopedia y Traumatología, Hospital General de Zona No. 51, Instituto Mexicano del Seguro Social. Gómez Palacio, Durango, México
| | - L A Valles-Flores
- Departamento de Educación e Investigación en Salud, Unidad de Medicina Familiar con Unidad Médica de Atención Ambulatoria UMF/UMAA 53, Instituto Mexicano del Seguro Social. Gómez Palacio, Durango, México
| | - R F Montes-Del Bosque
- Servicio de Ortopedia y Traumatología, Hospital Universitario «Dr. Joaquín del Valle Sánchez». Torreón, Coahuila. México
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El-Sayed M, Ahmed T, Fathy S, Zyton H. The effect of Dega acetabuloplasty and Salter innominate osteotomy on acetabular remodeling monitored by the acetabular index in walking DDH patients between 2 and 6 years of age: short- to middle-term follow-up. J Child Orthop 2012; 6:471-7. [PMID: 24294309 PMCID: PMC3511692 DOI: 10.1007/s11832-012-0451-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 10/31/2012] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The surgical management of neglected developmental dysplasia of the hip (DDH) in walking children has always been a challenge to orthopedic surgeons. The aim of this study was to evaluate the short- to middle-term clinical and radiographic results of the management of DDH. PATIENTS AND METHODS Patients less than 6 years old using two of the most commonly used osteotomies, namely, Salter innominate osteotomy and the Dega acetabuloplasty. Special attention was paid to acetabular remodeling after concentric reduction, which was monitored by the acetabular index, that, in turn, was measured preoperatively, immediately postoperatively, every 6 months, and at the final follow-up examination. RESULTS The final overall clinical end results were favorable (excellent or good) in 93 hips (85.3 %). There was a marked improvement of the acetabular coverage during the follow-up period, which proved the good remodeling potential of the acetabulum for this particular age group after concentric reduction was achieved and maintained. CONCLUSION Both osteotomy types were found to be adequate for the management of neglected walking DDH patients under the age of 6 years.
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Affiliation(s)
- Mohamed El-Sayed
- Department of Pediatric Orthopedic Surgery, and Limb Reconstructive Surgeries, Tanta University, 96, Hasan Radwan St., Dr. Mostafa Hosny Building, Tanta, Gharbia 3111 Egypt
| | - Tarek Ahmed
- Department of Pediatric Orthopedic Surgery, and Limb Reconstructive Surgeries, Tanta University, 96, Hasan Radwan St., Dr. Mostafa Hosny Building, Tanta, Gharbia 3111 Egypt
| | - Sameh Fathy
- Department of Pediatric Orthopedic Surgery, and Limb Reconstructive Surgeries, Tanta University, 96, Hasan Radwan St., Dr. Mostafa Hosny Building, Tanta, Gharbia 3111 Egypt
| | - Hosam Zyton
- Department of Pediatric Orthopedic Surgery, and Limb Reconstructive Surgeries, Tanta University, 96, Hasan Radwan St., Dr. Mostafa Hosny Building, Tanta, Gharbia 3111 Egypt
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