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Background: This study aimed to investigate the effect of different doses of dexmedetomidine combined with sufentanil on postoperative analgesia in developmental hip dislocation in children after Salter osteotomy. Methods: The clinical data of 98 children with developmental hip dislocation, who underwent Salter osteotomy in our center between January 2020 and February 2023, were selected. The children were randomly divided into four groups based on the application of patient-controlled intravenous analgesia (sufentanil + granisetron ± dexmedetomidine). All children received 1 µg/kg/day of sufentanil and 3 mg of granisetron. Group A did not receive dexmedetomidine, and Groups B, C, and D received 0.5, 0.75, and 1.0 µg/kg/day of dexmedetomidine, respectively. The pain indicators and immune factor levels of children in each group were compared. Results: The heart rate (HR) and respiratory rate (RR) 2 h after operation in Groups C and D were significantly lower than those in Groups A and B (P < 0.05). The pain scores decreased over time after treatment in all groups. When compared at the same time point, children in Group D had the lowest pain scores, which were significantly lower than the other three groups (P < 0.05). The total consumption of sufentanil in Groups C and D was significantly lower than that in Group A (P < 0.05). On the first day after surgery, the children in Group D had lower levels of serum adrenocorticotropic hormone, interleukin-6, and corticosterone than those in Group A (P < 0.05). Conclusion: Administration of 1.0 µg/kg/day of dexmedetomidine combined with sufentanil in intravenous controlled analgesia after Salter osteotomy for developmental hip dislocation in children has a better analgesic effect, less consumption of sufentanil, and low incidence of opioid adverse reactions.

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PURPOSE: Treatment outcomes of conservative and surgical treatment of Legg-Calvé-Perthes disease (LCPD) have been shown to be conditioned by a number of factors that may vary across different populations. This retrospective study aimed to evaluate factors affecting radiographically assessed treatment outcomes in patients treated surgically or conservatively for LCPD at Faculty Hospital Motol, Prague, Czech Republic, between the years 2006 and 2019. METHODS: Data of forty-seven children comprising 52 hips were analysed. Treatment outcomes were evaluated according to Stulberg classification. Predictors included the initial stage of fragmentation of the hip joint according to Herring classification, type of treatment (conservative or surgical), age at the time of diagnosis and sex. RESULTS: Older age and severity of LCPD according to Herring classification but not the type of treatment were the strongest factors determining treatment outcomes. Treatment outcomes were comparable in patients treated conservatively or surgically both across the whole cohort of patients and a group of young children < six years of age. CONCLUSIONS: Results strengthen the roles of severity of the LCPD at onset of treatment and age of the patient in predicting treatment outcomes in patients with LCPD. Conservative and surgical treatments appear to yield similar treatment outcomes irrespective of age of patients.

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We present a case of early onset osteoarthritis in a patient with Ehlers-Danlos syndrome (EDS) and a history of developmental dysplasia of the hip. Ehlers-Danlos syndrome (EDS) is part of a wide spectrum of connective tissue disorders characterized by hyperextensible skin, hypermobile joints, and tissue fragility. Presentation varies from mild hyperextensibility of the skin and joints to debilitating physical disabilities and vascular complications because of genetic defects in type one and three collagen synthesis. Collagen is the most abundant protein in nearly all parts of the body and errors in the production of this protein have widespread effects. Therefore, we suggest a multidisciplinary approach to the management of patients with EDS, with an emphasis on patient education, to aid in the prevention and early detection of complications.

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Background: If non-surgical treatment of Developmental Dysplasia of the Hip (DDH) fails or if DDH is late-detected, surgery is necessary. Salter pelvic osteotomy (SPO) is an effective surgical option for such cases. Objectives: To study the results after SPO; to evaluate risk factors; to reveal radiological parameters that may correlate with results. Methods: Results analysis in 17 patients (22 hips). Risk factors included those that do not depend on the surgeon (patient's age, value of the acetabular index (AI) preoperatively, DDH Tonnis grade) and those that depend on the surgeon (amount of AI correction). To radiological parameters which may correlate with the amount of AI correction we referred distance "d" and the lateral rotation angle. Results: SPO allows performing AI correction in ranges 24.1 ± 6.5°. Excellent and good clinical results were obtained in 95.5% of patients; excellent and good radiological results in 86.4% of patients. Risk factors that do not depend on the surgeon were older patient's age and higher preoperative AI values (p <0.05). The risk factor that depends on the surgeon was the amount of AI correction (p <0.05). The distance "d" was recognized as a radiological parameter that may indicate sufficient AI correction (p <0.05). Conclusion: In older patients with a higher preoperative AI value the results will be predictably worse. The surgeon may influence the result with a greater amount of AI correction (which may also be indicated radiologically by the distance "d" values). Level of evidence: IV, therapeutic, case series.

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Objective The study was aimed to compare the outcome of Salter's and Pemberton's osteotomy to achieve adequate acetabular coverage in the open reduction of developmental dysplastic hips (DDH). The functional outcome was evaluated as measured on Bhatti's Functional Score System (BFSS). Patients and methods The study includes 60 children with 82 hips of developmental dysplasia in walking-age children. They were operated on for open reduction and Salter's or Pemberton's pelvic osteotomy to achieve concentric anatomical reduction with good anterolateral coverage of the femoral head. Patients for Salter's and Pemberton's osteotomies were randomly selected. Preference was given to Pemberton's osteotomy in cases with double/irregular acetabulum and in bilateral DDH. All patients were operated on by a single surgeon from January 2014 to December 2016 and were followed up till June 2020. The overall radiological outcome was assessed on Severin's classification, comparing the pre and postoperative acetabular index (AI) and the clinical outcome on Bhatti's Functional Score System. Results The overall functional behavior on Bhatti's Functional Scoring revealed satisfactory outcome (excellent and good) in 73.17% (60/82) hips. On the radiological evaluation, 85.36% (70/82) hips achieved satisfactory development of hips (Severin Class IAB and IIAB) while 12.19% (10) hips developed a moderate deformity of the hip (Severin Class III; p>0.05). Comparing outcomes in both the Pemberton and Salter groups, the acetabular index significantly reduced after both procedures (p<0.05), however, the Pemberton group was more effective than the Salter group. Avascular necrosis (AVN) of Caput Femoris was noticed in 9.57% (8) hips, subluxations in 2.43% (2) hips, and impingement and stiffness in 12.19% (10) hips. Salter's group had more numbers of AVN and subluxations as compared to the Pemberton group, whereas impingement and stiffness were more in Pemberton's but none in the Salter group. Conclusion The hips with Pemberton's acetabuloplasty exhibited better acetabular coverage and progressive development of hips as compared to Salter's osteotomy group. Both groups, however, behaved equally on functional assessment with Bhatti's Functional Score System. The risk of subluxation and AVN was found higher in Salter's group, and femoroacetabular impingement in Pemberton's group. Pemberton's osteotomy was the best option for a single-stage open reduction in bilateral DDH in terms of less risk of bleeding, good stability, better postoperative pain control, and a second surgery to remove transfixation K-wires.

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BACKGROUND: Developmental dysplasia of the hip (DDH) is a common disease in infants and children, and the treatment of bilateral DDH remains controversial. This study aimed to evaluate the stability of one-stage bilateral Salter pelvic osteotomy for bilateral DDH in patients of walking age. METHODS: In total, nine child cadavers aged 2-6 years were included. A universal mechanical testing machine was used for stability test. We performed two different surgical procedures on the specimens: nine child cadavers underwent unilateral Salter pelvic osteotomy, and six child cadavers were randomly selected to undergo Salter pelvic osteotomy again to simulate one-stage bilateral Salter pelvic osteotomy. The stability of the bilateral sacroiliac joints, local stability of the operation area, ultimate load test, and axial stiffness were evaluated. RESULTS: Both unilateral and bilateral Salter osteotomy could destroy the integrity of the pelvic ring and increase the risk of pelvic instability. In this study, compared with unilateral Salter osteotomy, bilateral Salter osteotomy had similar pelvic stability, and there was no significant difference between unilateral and bilateral Salter osteotomy in sacroiliac joint stability (p > 0.05), local stability (p = 0.763), ultimate load (p = 0.328), and axial stiffness (p = 0.480). CONCLUSIONS: One-stage bilateral Salter pelvic osteotomy as a potential surgical method is viable and stable for children with bilateral DDH.

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PURPOSE: We aimed to evaluate the clinical and radiological outcomes of children older than 18 months who were treated with Salter osteotomy without open reduction for Tönnis type II hip dysplasia. METHODS: Thirty-two type II hips of 24 patients were included in the study. The mean age was 43.22 (18-108) months. The mean follow-up period was 50 (24-142) months. Seven patients had left sided, nine had right sided, and eight had bilateral developmental dysplasia of the hip. All patients underwent closed reduction and Salter osteotomy. Preoperative and postoperative radiographs were assessed by measuring the center-edge (CE) angle of Wiberg, Smith's c/b and h/b ratio, and acetabular index (AI). Patients were evaluated clinically according to McKay's criteria and radiologically according to Severin criteria. The Kalamchi and MacEwen criteria were used in the evaluation of avascular necrosis. RESULTS: The mean preoperative AI, CE angle, c/b, and h/b ratio were 36.7° (±4.1), 7.2° (±5.9), 0.9 (±0.08), and 0.05 (±0.04), respectively. The mean latest follow-up AI, CE angle, c/b, and h/b ratio were 18.2° (±1.7), 38.8° (±5.4), 0.6 (±0.03), and 0.19 (±0.04), respectively. The comparison of preoperative and postoperative radiological values revealed statistically significant improvement ( p < 0.01). On the latest physical examinations of the patients, 25 (78.1%) hips were rated excellent, and 7 (21.9%) were rated good according to the McKay criteria. The Severin classification determined 25 (78.1%) hips were grade I and 7 (21.9%) hips were grade II. Type I avascular necrosis (AVN) was seen in four (12.5%) hips. Three of these four hips were more superolateral in preoperative radiographs (c/b > 1 and h/b < 0.05). CONCLUSIONS: Salter osteotomy without open reduction is a good surgery option for Tönnis type II hip dysplasia, in which closed reduction can be performed. However, the risk of AVN should be kept in mind in more superolateral type 2 hips.

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BACKGROUND: Developmental dysplasia of the hip (DDH) is one of the most important and challenging conditions in the field of pediatric orthopedics; if not diagnosed and treated in time, it would lead to remarkable morbidity. Methods of treatment based on the patient's age can vary. The aim of this study is to compare the outcomes of Salter osteotomy surgery in two groups of patients under and over three years old. METHODS: In this retrospective study, medical records of patients who had undergone innominate Salter osteotomy, within the past ten years, due to non-pathological DDH were collected. Mean follow up of all patients is 70.28 months (min=25, max=118). RESULTS: eventy patients were selected including 85 operated hips. Radiological satisfaction based on modified Severin score system rate was 86% and 85% for lower three years old group and second group, respectively. In clinical assessment, it was found that results in 82% of the patients under 3 years old and 82.9% of patients older than three years old were satisfactory. There was no statistically significant difference between the two groups based on Modified MacKay criterion. CONCLUSION: Results in both groups of patients under and over 3 years old were found satisfactory. Difference in patient satisfaction rates based on clinical and radiological outcomes was not statistically significant between the two groups. It should also be noted that complications such as redislocation and deep wound infection would cause poor clinical and radiological outcomes.

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OBJECTIVE: To document the clinical presentation of neglected DDH and evaluate the outcome of triple procedure. METHODS: It was a descriptive case series study, conducted at the Department of Orthopedic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad over a period of 8-years. It included children aged >1 and <9 years who underwent the triple procedure of open reduction, femoral shortening and Salter's osteotomy. Clinical evaluation was performed using McKay's criteria. Tonnis classification and Severin's scoring system were employed for the radiological evaluation. RESULTS: There were 193 children with 213 DDH affected hips. The mean age was 3.31±1.6 years. The preoperative severity of the femoral head dislocation per Tonnis classification was Grade-I in 7.98%(n=17), Grade-II in 48.35%(n=103) and Grade-III in 43.66%(n=93) hips. The postoperative MacKay criteria was 'Good' to 'Excellent' in 193(90.61%) hips. The postoperative Severin's class was I in 113(53%) hips, II in 48(22.53%) hips, III in 43(20.18%) and IV in 9(4.22%) hips. The preoperative acetabular index ranged from 39° to 51° with a mean of 43.91±3.69°. The mean postoperative AI was 18.42±2.99°. The postoperative centre edge angle ranged from 21° to 26° with a mean 23.18 ±1.35°. CONCLUSIONS: The single stage triple procedure offers the surgical remedy of choice with favourable results for managing neglected and late diagnosed DDH among children aged 1-8 years.

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AIMS: This study compared the long-term results following Salter osteotomy and Pemberton acetabuloplasty in children with developmental dysplasia of the hip (DDH). We assessed if there was a greater increase in pelvic height following the Salter osteotomy, and if this had a continued effect on pelvic tilt, lumbar curvature or functional outcomes. PATIENTS AND METHODS: We reviewed 42 children at more than ten years post-operatively following a unilateral Salter osteotomy or Pemberton acetabuloplasty. We measured the increase in pelvic height and the iliac crest tilt and sacral tilt at the most recent review and at an earlier review point in the first decade of follow-up. We measured the lumbar Cobb angle and the Short Form-36 (SF-36) and Harris hip scores were collected at the most recent review. RESULTS: During the first decade of follow-up, there was a greater increase in pelvic height in the children who had a Salter osteotomy (Salter, 10.1%; Pemberton, 4.3%, p < 0.001). The difference in the increase in pelvic height was insignificant at the most recent review (Salter, 4.4%; Pemberton, 3.1%, p = 0.249). There was no significant difference between the two groups for the lumbar Cobb angle, (Salter, 3.1°; Pemberton, 3.3°, p = 0.906). A coronal lumbar curve was seen in 41 children (97%), 30 of these had a compensatory curve. Sacral tilt was the radiographic parameter for pelvic imbalance that correlated most with the lumbar Cobb angle (Pearson correlation co-efficient 0.59). The Harris hip score and SF-36 were good and showed no differences between the two groups. CONCLUSION: In the long-term, we found no difference in the functional results or pelvic imbalance between Salter osteotomy and Pemberton acetabuloplasty in the management of children with DDH. Cite this article: Bone Joint J 2016;98-B:1145-50.

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BACKGROUND: The principles of treatment of congenital dislocation of hip in old children are different than those of infants and neonates. The purpose of this study is to evaluate the radiographic and functional results of one-stage treatment (open reduction, femoral shortening derotation, and Salter's osteotomy) of DDH in older children. MATERIALS AND METHODS: Between January 2005 and June 2010, 25 patients (30 hips) underwent one-stage triple procedure of open reduction, femoral shortening derotation, and Salter's osteotomy for the treatment of DDH. Preoperatively, they were classified according to the Tönnis class. Clinical outcomes were assessed using the modified McKay's criteria to measure pain symptoms, gait pattern, Trendelenburg sign status, and the range of hip joint movement. Radiographic assessment was made using Severin's scoring method to measure the centre-edge angle and dysplasia. RESULTS: The mean age at the time of operation was 3.9 years (range 1.6-8 years), and the average duration of followup was 4.1 years (range 2-7.6 years). The McKay's score was excellent in 13 hips, good in 14 hips, fair in 2, and poor in 1 hip. The Severin's class I and II was found in 25 (83.3%) hips at the time of final evaluation as compared to none at the time of presentation. CONCLUSIONS: Young children having DDH can safely be treated with an extensive one-stage triple procedure of open reduction, femoral shortening derotation, and Salter's osteotomy, without increasing the risk of AVN. Early diagnosis and intervention is the successful treatment of patients suffering from DDH.

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BACKGROUND: The treatment of late-presenting developmental dislocation of the hip (DDH) is still controversial. A consecutive series of 32 patients not previously treated (43 hips, Tönnis grade 3 or 4) underwent progressive closed reduction followed immediately by innominate osteotomy between 1964 and 1976. They were between 1.5 and 5 years old at the time of pelvic osteotomy. This study was designed to check the outcome of these patients more than 30 years later. METHODS: Eight patients living outside of France (North Africa) could not be reached and one patient had died of an unrelated cause. The remaining 23 patients (32 hips) were reviewed with clinical assessment (Merle d'Aubigné, Harris and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] scores) and anteroposterior (AP) pelvic radiograph. This represents a 75% rate of follow up at 31 to 44 years post-operatively. RESULTS: In two patients, surgery was repeated due to residual subluxation. Only one patient needed a total hip replacement (THR) 33 years after initial treatment. The Merle d'Aubigné, Harris and WOMAC scores for the surviving hips were excellent or good in almost 80% of the cases. In four cases, radiographic signs "at risk for" osteoarthritis were present. Regularity of the femoral head was perfect in seven hips, regular in 18 and irregular in six. According to the Severin-Seringe classification, 25 hips could be classified as group I (14 group IA and 11 group IB), three group II and three group VII. CONCLUSION: The long-term results of non-previously treated late-presenting DDH by the technique of progressive closed reduction followed by innominate osteotomy are quite good and compare favourably with the long-term results of open reduction with the same osteotomy.

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0.05),and Salter pelvic osteotomy could significantly decrease the acetabular anteversion(P

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Objective To analyse the femoral head coverage rate of CT in evaluation of Salter osteotomy for developmental dislocation of hip(DDH) in children. Methods Thirty-eight patients with unilateral DDH for Salter osteotomy were enrolled,and X ray photography of pelvis and spiral CT scanning of femoral articulation were performed one week before and 6 months after Salter osteotomy.The femoral head coverage rate of X ray and that of CT were calculated and compared.Another 38 children with normal femoral articulation were served as controls. Results The femoral head coverage rate of X ray was significantly higher than that of CT in patients with DDH(P

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The center-edge (CE) angle was measured on serial antero-posterior radiographs of 44 hips treated by Salter's innominate osteotomy for developmental dysplasia of the hip. Radiographic examination according to Severin was performed and the peak hip joint pressure was calculated using geometrical parameters determined from radiographs at the most recent follow-up examination, 7 to 13 years postoperatively.At the latest follow-up assessment, there was a positive correlation between the postoperative CE angle and radiographic results. Negative correlation was found between the postoperative CE angle and peak hip joint pressure at the latest follow up.In conclusion, Salter's osteotomy performed to treat developmental dysplasia of the hip should involve radical acetabular correction resulting in maximum increase of the CE angle.