Orthopedics - Oleksa A.P. 2006

Congenital and Acquired Deformities of the Lower Extremity
Congenital and Acquired Deformities of the Hip
High-Riding Greater Trochanter

High positioning of the greater trochanter is a manifestation of growth disturbances in the epiphyseal growth plate situated beneath the femoral HEAD.

According to M. Treder et al. (1998), subcapital growth disturbances are typically caused by ischemia during the Treatment of developmental Dysplasia of the hip, and less frequently by inflammation within the joint (15%), congenital coxa vara (13%), or Perthes disease (6%).

High positioning of the greater trochanter leads to laxity of the gluteal Muscle group and their functional-dynamic insufficiency, which clinically manifests as impaired gait biomechanics, restricted hip abduction, and a positive Trendelenburg sign.

Radiographic examination reveals all of the aforementioned pathological developmental Changes in the proximal Femur.

Clinically and radiographically diagnosed high positioning of the greater trochanter requires surgical intervention, which consists of its transposition.

To reliably restore the functional state of the hip abductor Muscles, it is essential to lower the greater trochanter to such a level that its apex lies at the center of Rotation of the femoral head or slightly below it.

Surgical technique. Under general anesthesia, a 15 cm lateral linear incision is made, extending downward from the supra-trochanteric region. The soft Tissues and periosteum of the subtrochanteric region of the femur are incised and reflected laterally. The greater trochanter is exposed anteriorly and posteriorly using a scalpel, and osteotomized obliquely from bottom to top using an osteotome. The gluteal Muscles Attached to the trochanter are mobilized, and the trochanter is displaced distally into the subtrochanteric region of the femur, where it is temporarily fixed with two Kirschner wires. Limb movements are performed to verify the correct positioning of the trochanter attachment site. Afterward, an osteotome is used to mark the femur, the wires are removed, the trochanter is retracted, and the cortical layer is abraded until bleeding occurs at the intended fusion site. The Contact surfaces of the trochanter and femur are apposed and secured with a cancellous screw. The wound is closed and drained for 24 hours. A short knee-level hip spica cast is applied, which can be removed after 6 weeks.

Postoperatively, the lever arm is lengthened and the tension force of the gluteal muscles is increased, which stabilizes the hip joint, improves its biomechanics, and eliminates the positive Trendelenburg sign.