RESUMEN
Abstract Developmental dysplasia of the hip (DDH) is a condition characterized by changes in joint formation within the last months of intrauterine life or the first months after birth. Developmental dysplasia of the hip presentation ranges from femoroacetabular instability to several stages of dysplasia up to complete dislocation. Early diagnosis is essential for successful treatment. Clinical screening, including appropriate maneuvers, is critical in newborns and subsequent examinations during the growth of the child. Infants with suspected DDH must undergo an ultrasound screening, especially those with a breech presentation at delivery or a family history of the condition. A hip ultrasound within the first months, followed by pelvic radiograph at 4 or 6 months, determines the diagnosis and helps follow-up. Treatment consists of concentric reduction and hip maintenance and stabilization with joint remodeling. The initial choices are flexion/abduction orthoses; older children may require a spica cast after closed reduction, with or without tenotomy. An open reduction also can be indicated. After 18 months, the choices include pelvic osteotomies with capsuloplasty and, eventually, acetabular and femoral osteotomies. The follow-up of treated children must continue throughout their growth due to the potential risk of late dysplasia.
Resumo O termo displasia do desenvolvimento quadril (DDQ) refere-se à condição na qual a articulação sofre alterações na sua formação durante os últimos meses da vida intrauterina ou nos primeiros meses após o nascimento. No espectro de apresentação, varia desde a instabilidade femuroacetabular, passando por estádios de displasia até a completa luxação. O diagnóstico precoce é fundamental para o sucesso do tratamento. A triagem através do exame clínico incluindo manobras apropriadas é imprescindível nos recém-nascidos e nas avaliações subsequentes durante o crescimento da criança. O rastreamento ultrassonográfico é indicado nos bebês sob suspeita clínica e muito mais recomendável naqueles que tiveram apresentação pélvica para o parto ou que tenham antecedentes familiares. A ultrassonografia do quadril nos primeiros meses seguida da radiografia da bacia após o 4° ou 6° mês de vida são os exames que determinam o diagnóstico e auxiliam o seguimento. O tratamento está baseado na obtenção de uma redução concêntrica e na manutenção e estabilização do quadril, propiciando a remodelação articular. Inicialmente, as órteses de flexão/abdução são a escolha; em crianças maiores pode ser necessário o uso de gesso após redução incruenta com ou sem tenotomia; redução aberta pode ser indicada e após os 18 meses as osteotomias pélvicas associadas a capsuloplastia e eventuais osteotomias acetabular e femoral. Crianças tratadas devem ser acompanhadas durante todo o seu crescimento pelo eventual risco de displasias tardias.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Displasia del Desarrollo de la Cadera/terapia , Displasia del Desarrollo de la Cadera/diagnóstico por imagen , Luxación Congénita de la Cadera/diagnóstico , Luxación Congénita de la Cadera/terapiaRESUMEN
OBJECTIVES: To provide an insight of the incidence of congenital developmental dysplasia of the hip in newborns from Yucatan born between 2015 and 2019 and analyze its association with maternal sociodemographic characteristics and neonatal, pregnancy and delivery related aspects. METHODS: Retrospective, population-based study from Birth Registries database in Yucatan, Mexico between 2015 and 2019. Presence of hip dysplasia was described and analyzed considering three aspects (I) Maternal information (II) Pregnancy and birth (III) Neonatal examination. We obtained incidence rates from each year and the complete studied period. Association between hip dysplasia and maternal, neonatal and pregnancy/delivery variables was analyzed using logistic regression, unadjusted odds ratio and an adjusted model. RESULTS: Hip dysplasia occurred in 13 per 10 000 live births. Significant associations were found between hip dysplasia and maternal place of residence in a city <50 000 inhabitants, without a local clinic. Propensity to give birth to a neonate with hip dysplasia increased with maternal age and ethnicity, in female newborns and when total number of pregnancy consultations summed <5. Newborns with hip dysplasia were heavier and less susceptible to be delivered vaginally. Congenital developmental hip dysplasia was comparatively more frequent among offspring of Mayan women and suboptimal access to medical care during pregnancy. Female neonates were affected the most, those first-borns. Neonates with hip dysplasia were heavier and more susceptible to be born by cesarean section. CONCLUSION: Maternal, neonatal, and perinatal factors are associated with DDH in Yucatecan infants born during 2015-2019. Factors that describe living conditions seems to have a more important effect on the presence of this condition.
Asunto(s)
Displasia del Desarrollo de la Cadera , Luxación Congénita de la Cadera , Luxación de la Cadera , Cesárea , Etnicidad , Femenino , Luxación Congénita de la Cadera/diagnóstico , Luxación Congénita de la Cadera/epidemiología , Humanos , Lactante , Recién Nacido , México/epidemiología , Embarazo , Estudios Retrospectivos , Factores de RiesgoRESUMEN
La displasia del desarrollo de la cadera (DDC) es una anomalía de la articulación coxofemoral caracterizada por una laxitud o posicionamiento anormal de la cabeza femoral con respecto al acetábulo. Es la patología ósea perinatal más frecuente, e incluye alteraciones que van desde el aplanamiento o la displasia acetabular hasta una luxación completa de la cabeza femoral fuera de la articulación, que puede comprometer el desarrollo y la estabilidad articular. Nuestro objetivo es transmitir una sistemática de estudio en la valoración de la cadera del recién nacido, haciendo énfasis en un examen físico correcto como pilar fundamental en la detección de la DDC, y orientar al pediatra en la selección adecuada del método diagnóstico complementario acorde a edad del paciente, con el fin de optimizar la detección y reducir el número de caderas luxadas en etapas tempranas y tardías, y así disminuir la incidencia de patologías asociadas desarrolladas a partir de este trastorno
Developmental dysplasia of the hip (DDH) is a hip joint anomaly that is characterized by a laxity or abnormal positioning of the femoral head with respect to the acetabulum. It is the most common perinatal pathology of the skeleton and includes a spectrum of alterations ranging from flattening or acetabular dysplasia, to a complete dislocation of the femoral head outside the joint that can compromise joint development and stability. The purpose of this presentation is to transmit a systematic study in the evaluation of the newborn's hip, emphasizing a correct physical examination as primordial in the detection of DDH. Also, guide the pediatriciain the proper selection of the complementary diagnostic method to be used according to the age of the patient, in order to optimize detection and reduce the number of dislocated hips in early and late stages as well as the incidence of related pathologies.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Displasia del Desarrollo de la Cadera/diagnóstico , Examen Físico/métodos , Factores de Riesgo , Diagnóstico Precoz , Displasia del Desarrollo de la Cadera/etiología , Luxación Congénita de la Cadera/diagnóstico , Luxación Congénita de la Cadera/etiologíaRESUMEN
Developmental dysplasia of the hip (DDH) is a hip joint anomaly that is characterized by a laxity or abnormal positioning of the femoral head with respect to the acetabulum. It is the most common perinatal pathology of the skeleton and includes a spectrum of alterations ranging from flattening or acetabular dysplasia, to a complete dislocation of the femoral head outside the joint that can compromise joint development and stability. The purpose of this presentation is to transmit a systematic study in the evaluation of the newborn's hip, emphasizing a correct physical examination as primordial in the detection of DDH. Also, guide the pediatrician in the proper selection of the complementary diagnostic method to be used according to the age of the patient, in order to optimize detection and reduce the number of dislocated hips in early and late stages as well as the incidence of related pathologies.
La displasia del desarrollo de la cadera (DDC) es una anomalía de la articulación coxofemoral caracterizada por una laxitud o posicionamiento anormal de la cabeza femoral con respecto al acetábulo. Es la patología ósea perinatal más frecuente, e incluye alteraciones que van desde el aplanamiento o la displasia acetabular hasta una luxación completa de la cabeza femoral fuera de la articulación, que puede comprometer el desarrollo y la estabilidad articular. Nuestro objetivo es transmitir una sistemática de estudio en la valoración de la cadera del recién nacido, haciendo énfasis en un examen físico correcto como pilar fundamental en la detección de la DDC, y orientar al pediatra en la selección adecuada del método diagnóstico complementario acorde a edad del paciente, con el fin de optimizar la detección y reducir el número de caderas luxadas en etapas tempranas y tardías, y así disminuir la incidencia de patologías asociadas desarrolladas a partir de este trastorno.
Asunto(s)
Displasia del Desarrollo de la Cadera , Luxación Congénita de la Cadera , Acetábulo , Luxación Congénita de la Cadera/diagnóstico , Luxación Congénita de la Cadera/epidemiología , Articulación de la Cadera , Humanos , Tamizaje MasivoRESUMEN
RESUMEN Se presentó el caso de una niña con el diagnóstico de displasia de Meyer. Consiste en una alteración en el desarrollo de la cadera en el niño dado por irregularidad y retraso en la osificación del núcleo de la epífisis femoral, aunque muchos ortopedistas la consideran como una variante fisiológica normal. Radiológicamente se manifiesta como un patrón granular múltiple de osificación y clínicamente si bien puede ser sintomática en algunos casos, lo más frecuente es que sea asintomática. Se enfatizó en la importancia de considerar a la displasia de Meyer como posibilidad diagnóstica ante alteraciones en la osificación de la epífisis femoral. Se señaló a la displasia congénita de la cadera y la enfermedad de Perthes como principales entidades a tener en cuenta al hacer el diagnóstico diferencial. Se analizó la evolución clínico-radiológica de la paciente a partir de los datos recogidos en la historia clínica. Se concluyó enfatizando que la displasia de Meyer debe tenerse presente como posibilidad diagnóstica ante casos similares, realizar una cuidadosa valoración de cada paciente y tener en cuenta a la displasia congénita de la cadera y la enfermedad de Perthes como diagnóstico diferencial atendiendo a la edad del paciente (AU).
ABSTRACT The authors present the case of a female child diagnosed with Meyers dysplasia. It is an alteration of the hip development in children, given the ossification irregularity and retardation of the femoral epiphysis nucleus, although several orthopedists consider it a normal physiological variant. Radiologically, it shows like a multiple granular pattern of ossification, and clinically it could be symptomatic in several cases, but more frequently it is asymptomatic. It was emphasized the importance of considering Meyer dysplasia as a diagnostic possibility in the presence of alterations in the femoral epiphysis ossification. The authors indicated hip congenital dysplasia and Perthes disease as main entities to take into account when making the differential diagnosis. They also analyzed clinic-radiological evolution of the patient on the basis of the data collected in the clinical record. They concluded emphasizing that Meyer dysplasia must be taken into consideration as a diagnostic possibility in similar cases, each patient should be carefully assessed and that hip congenital dysplasia and Perthes disease have to be considered as differential diagnosis given the age of the patient (AU).
Asunto(s)
Humanos , Femenino , Niño , Niño , Luxación Congénita de la Cadera/diagnóstico , Radiología , Evolución Clínica , Diagnóstico Diferencial , Enfermedad de Legg-Calve-Perthes/congénito , Enfermedad de Legg-Calve-Perthes/diagnósticoRESUMEN
OBJECTIVE: to evaluate newborns with suspected hip instability, referred by pediatricians to a tertiary orthopedic service. METHODS: newborns from a public university maternity hospital, with suspected instability or risk factors for hip dysplasia, were referred to the Department of Orthopedics and Anesthesiology, Ribeirão Preto/SP, where we evaluated them clinically and through ultrasound examinations of the hips. Once we found dysplasia, we initiated treatment, and in cases in which there was only hip immaturity and normal clinical examination, we performed clinical and ultrasound observation and review at two or three months of age. RESULTS: we examined 448 newborns, with female predominance and average age at first evaluation of 27 days. The main cause of referral was pelvic presentation at delivery. In 8% there was a positive Ortolani sign and in 12.5%,. At orthopedic examination, 405 (90.5%) patients were normal, 8.5% had hip click and 1.1% had positive Ortolani test. At ultrasound, 368 (89.5%) had immaturity, 26 (6.3%) had moderate dysplasia and in 17 (4.1%) patients the hips were frankly dysplastic. All cases with positive Ortolani sign showed dysplasia at ultrasound. CONCLUSION: there was an excess diagnosis of hip instability in the pediatrician evaluation, which, however, allowed the patient a second assessment, in a more specialized environment and with more technological resources.
OBJETIVO: avaliar recém-nascidos com suspeita de instabilidade do quadril, encaminhados por pediatras a um serviço ortopédico terciário. MÉTODOS: recém-nascidos de uma maternidade pública universitária, com suspeita de instabilidade ou fatores de risco para displasia do quadril, eram encaminhados ao Departamento de Ortopedia e Anestesiologia, Ribeirão Preto/SP, onde eram avaliados clinicamente e através de exames ultrassonográficos dos quadris. Constatada a displasia, iniciava-se o tratamento, e em casos em que havia apenas imaturidade do quadril e exame clínico normal, procedia-se à observação e re-exame clinico e ultrassonográfico com dois ou três meses de vida. RESULTADOS: foram examinados 448 recém-nascidos, com predominância feminina e média de idade na primeira avaliação de 27 dias. A principal causa do encaminhamento foi apresentação pélvica. Em 8% havia sinal de Ortolani positivo e em 12,5% estalido no quadril. No exame ortopédico, 405 (90,5%) pacientes eram normais, 8,5% apresentavam estalido no quadril e 1,1% apresentavam teste de Ortolani positivo. À ultrassonografia, 368 (89,5%) apresentavam imaturidade, 26 (6,3%) tinham displasia moderada e em 17 (4,1%) pacientes os quadris eram francamente displásicos. Todos os casos com sinal de Ortolani positivo apresentavam quadro ultrassonográfico de displasia. CONCLUSÃO: houve excesso de diagnóstico de instabilidade do quadril na avaliação do pediatra, o que, no entanto, permitiu ao paciente uma segunda avaliação, em ambiente mais especializado e com mais recursos tecnológicos.
Asunto(s)
Luxación Congénita de la Cadera/diagnóstico , Luxaciones Articulares/diagnóstico , Inestabilidad de la Articulación/diagnóstico , Estudios Transversales , Femenino , Luxación Congénita de la Cadera/terapia , Humanos , Lactante , Recién Nacido , Luxaciones Articulares/terapia , Inestabilidad de la Articulación/terapia , Masculino , Dispositivos de Fijación Ortopédica , Procedimientos Ortopédicos/instrumentación , Examen Físico , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , UltrasonografíaRESUMEN
RESUMO Objetivo: avaliar recém-nascidos com suspeita de instabilidade do quadril, encaminhados por pediatras a um serviço ortopédico terciário. Métodos: recém-nascidos de uma maternidade pública universitária, com suspeita de instabilidade ou fatores de risco para displasia do quadril, eram encaminhados ao Departamento de Ortopedia e Anestesiologia, Ribeirão Preto/SP, onde eram avaliados clinicamente e através de exames ultrassonográficos dos quadris. Constatada a displasia, iniciava-se o tratamento, e em casos em que havia apenas imaturidade do quadril e exame clínico normal, procedia-se à observação e re-exame clinico e ultrassonográfico com dois ou três meses de vida. Resultados: foram examinados 448 recém-nascidos, com predominância feminina e média de idade na primeira avaliação de 27 dias. A principal causa do encaminhamento foi apresentação pélvica. Em 8% havia sinal de Ortolani positivo e em 12,5% estalido no quadril. No exame ortopédico, 405 (90,5%) pacientes eram normais, 8,5% apresentavam estalido no quadril e 1,1% apresentavam teste de Ortolani positivo. À ultrassonografia, 368 (89,5%) apresentavam imaturidade, 26 (6,3%) tinham displasia moderada e em 17 (4,1%) pacientes os quadris eram francamente displásicos. Todos os casos com sinal de Ortolani positivo apresentavam quadro ultrassonográfico de displasia. Conclusão: houve excesso de diagnóstico de instabilidade do quadril na avaliação do pediatra, o que, no entanto, permitiu ao paciente uma segunda avaliação, em ambiente mais especializado e com mais recursos tecnológicos.
ABSTRACT Objective: to evaluate newborns with suspected hip instability, referred by pediatricians to a tertiary orthopedic service. Methods: newborns from a public university maternity hospital, with suspected instability or risk factors for hip dysplasia, were referred to the Department of Orthopedics and Anesthesiology, Ribeirão Preto/SP, where we evaluated them clinically and through ultrasound examinations of the hips. Once we found dysplasia, we initiated treatment, and in cases in which there was only hip immaturity and normal clinical examination, we performed clinical and ultrasound observation and review at two or three months of age. Results: we examined 448 newborns, with female predominance and average age at first evaluation of 27 days. The main cause of referral was pelvic presentation at delivery. In 8% there was a positive Ortolani sign and in 12.5%,. At orthopedic examination, 405 (90.5%) patients were normal, 8.5% had hip click and 1.1% had positive Ortolani test. At ultrasound, 368 (89.5%) had immaturity, 26 (6.3%) had moderate dysplasia and in 17 (4.1%) patients the hips were frankly dysplastic. All cases with positive Ortolani sign showed dysplasia at ultrasound. Conclusion: there was an excess diagnosis of hip instability in the pediatrician evaluation, which, however, allowed the patient a second assessment, in a more specialized environment and with more technological resources.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Luxaciones Articulares/diagnóstico , Luxación Congénita de la Cadera/diagnóstico , Inestabilidad de la Articulación/diagnóstico , Dispositivos de Fijación Ortopédica , Examen Físico , Índice de Severidad de la Enfermedad , Estudios Transversales , Estudios Retrospectivos , Factores de Riesgo , Ultrasonografía , Procedimientos Ortopédicos/instrumentación , Luxaciones Articulares/terapia , Luxación Congénita de la Cadera/terapia , Inestabilidad de la Articulación/terapiaRESUMEN
OBJECTIVE: To determine the incidence and associated risk factors of developmental dysplasia of the hip (DDH) in a modern population without universal screening. STUDY DESIGN: Children with DDH were identified from the Manitoba Centre for Health Policy's Data Repository by the use of International Classification of Diseases diagnosis codes as well as physician billing tariffs for surgical procedures for DDH for all children born between 1995 and 2012. To identify the outpatient-treated patients, ultrasound scans and radiographic imaging for DDH were reviewed for 2004-2012. Overall incidence was calculated on the basis of birth rate for the province per year. Relative risks of sex, first born, breech position, clubfoot deformity, multiple gestations, as well as regional health areas were analyzed with χ2 tests. RESULTS: We identified 1716 cases of DDH of 258 499 newborns. The incidence of DDH was calculated at 6.6/1000 newborns. Late-presenting DDH was detected in 2.2/1000 newborns. Female first-born children, clubfoot deformity, and breech position were associated significantly with an increased risk. Children with DDH born in rural areas of the Northern and Central part of Manitoba presented at a later age than those who are born in the urban areas (P < .0001) CONCLUSION: This study shows the need for improved early detection and awareness at well-baby clinics of risk factors and regional differences for DDH.
Asunto(s)
Luxación Congénita de la Cadera/epidemiología , Estudios de Cohortes , Diagnóstico Precoz , Femenino , Luxación Congénita de la Cadera/diagnóstico , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Manitoba/epidemiología , Tamizaje Neonatal/métodos , Estudios Retrospectivos , Riesgo , Factores de RiesgoRESUMEN
Algunos autores plantean que la medición radiográfica de la cadera en etapa cartilaginosa, se dificulta por la no visualización en las radiografías del núcleo osificado de la cabeza del fémur, lo que compromete la determinación exacta de la relación entre cabeza femoral y acetábulo. En este artículo se expone la metodología para la evaluación radiológica de la cadera con desarrollo displásico desde la etapa cartilaginosa. Para ello, se utilizó una radiografía simple anteroposterior de la pelvis en etapa cartilaginosa, donde la cabeza del fémur no es visible. La metodología propuesta tiene como elemento inicial la determinación de puntos de referencia, presentes desde la etapa de recién nacido y sobre los cuales se realizan mediciones y ángulos, lo que permite establecer grupos diagnósticos y dar seguimiento en el tiempo hasta la curación de la afección(AU)
Some authors suggest that hip radiographic measurement in the cartilaginous stage is difficult by the non-visualization in the x-rays of the femoral head ossified nucleus, which compromises the exact determination of the relation between the femoral head and the acetabulum. This article describes the methodology for radiological evaluation of the hip with dysplastic development from the cartilaginous stage. For this, a simple anteroposterior pelvis radiograph was used in the cartilaginous stage, where the femoral head is not visible. The proposed methodology has as initial element the determination of reference points that are present from the newborn stage and on which measurements and angles are made. It allows to establish diagnostic groups and to provide follow up in time until curing the condition(AU)
Asunto(s)
Humanos , Recién Nacido , Radiografía/métodos , Radiografía , Luxación Congénita de la Cadera/diagnóstico , Luxación Congénita de la CaderaRESUMEN
INTRODUCTION: Because of the risk of developmental dysplasia of the hip in infants born breech-despite a normal physical exam-the American Academy of Pediatrics (AAP) guidelines recommend ultrasound (US) hip imaging at 6 weeks of age for breech females and optional imaging for breech males. The purpose of this study is to report US results and follow-up of infants born breech with a normal physical exam. METHODS: The electronic medical record for children born at 1 hospital from 2008 to 2011 was reviewed. Data were analyzed for sex, birth weight, breech position, birth order, ethnicity, US and x-ray results, follow-up, and cost. RESULTS: A total of 237 infants were born breech with a normal physical examination, all delivered by cesarean section. Of the infants, 55% were male and 45% female. About 151 breech infants (64%) with a normal Barlow and Ortolani exam had a precautionary hip US as recommended by the AAP performed at an average of 7 weeks of age. Eighty-six breech infants (35%) did not have an US and were followed clinically. Of the 151 infants that had an US, 140 (93%) were read as normal. None had a dislocated hip. Two patients had a normal physical exam but laxity on US. These 2 patients were the only infants treated in a Pavlik harness. A pediatric orthopaedic surgeon followed those with subtle US findings and no laxity until normal. CONCLUSIONS: The decision by the AAP to recommend US screening at 6 weeks of age for infants with a normal physical exam but breech position was based on an extensive literature review and expert opinion. Not all pediatricians are following the AAP guidelines. The decision to perform an US should be done on a case-by-case basis by the examining physician. A more practical, cost-effective strategy would be to skip the US if the physical exam is normal and simply obtain an AP pelvis x-ray at 4 months. LEVEL OF EVIDENCE: Level III-this is a case-control study investigating the outcomes of infants on data drawn from the electronic medical record.
Asunto(s)
Presentación de Nalgas/cirugía , Luxación Congénita de la Cadera/diagnóstico , Inestabilidad de la Articulación/diagnóstico , Ultrasonografía/métodos , Estudios de Casos y Controles , Cesárea/métodos , Femenino , Humanos , Lactante , Masculino , Examen Físico/métodos , Embarazo , Medición de Riesgo/métodosRESUMEN
BACKGROUND: Little information exists concerning the variability of presentation and differences in treatment methods for developmental dysplasia of the hip (DDH) in children < 18 months. The inherent advantages of prospective multicenter studies are well documented, but data from different centers may differ in terms of important variables such as patient demographics, diagnoses, and treatment or management decisions. The purpose of this study was to determine whether there is a difference in baseline data among the nine centers in five countries affiliated with the International Hip Dysplasia Institute to establish the need to consider the center as a key variable in multicenter studies. QUESTIONS/PURPOSES: (1) How do patient demographics differ across participating centers at presentation? (2) How do patient diagnoses (severity and laterality) differ across centers? (3) How do initial treatment approaches differ across participating centers? METHODS: A multicenter prospective hip dysplasia study database was analyzed from 2010 to April 2015. Patients younger than 6 months of age at diagnosis were included if at least one hip was completely dislocated, whereas patients between 6 and 18 months of age at diagnosis were included with any form of DDH. Participating centers (academic, urban, tertiary care hospitals) span five countries across three continents. Baseline data (patient demographics, diagnosis, swaddling history, baseline International Hip Dysplasia Institute classification, and initial treatment) were compared among all nine centers. A total of 496 patients were enrolled with site enrolment ranging from 10 to 117. The proportion of eligible patients who were enrolled and followed at the nine participating centers was 98%. Patient enrollment rates were similar across all sites, and data collection/completeness for relevant variables at initial presentation was comparable. RESULTS: In total, 83% of all patients were female (410 of 496), and the median age at presentation was 2.2 months (range, 0-18 months). Breech presentation occurred more often in younger (< 6 months) than in older (6-18 months at diagnosis) patients (30% [96 of 318] versus 9% [15 of 161]; odds ratio [OR], 4.2; 95% confidence interval [CI], 2.3-7.5; p < 0.001). The Australia site was underrepresented in breech presentation in comparison to the other centers (8% [five of 66] versus 23% [111 of 479]; OR, 0.3, 95% CI, 0.1-0.7; p = 0.034). The largest diagnostic category was < 6 months, dislocated reducible (51% [253 of 496 patients]); however, the Australia and Boston sites had more irreducible dislocations compared with the other sites (ORs, 2.1 and 1.9; 95% CIs, 1.2-3.6 and 1.1-3.4; p = 0.02 and 0.015, respectively). Bilaterality was seen less often in older compared with younger patients (8% [seven of 93] versus 26% [85 of 328]; p < 0.001). The most common diagnostic group was Grade 3 (by International Hip Dysplasia Institute classification), which included 58% (51 of 88) of all classified dislocated hips. Splintage was the primary initial treatment of choice at 80% (395 of 496), but was far more likely in younger compared with older patients (94% [309 of 328] versus 18% [17 of 93]; p < 0.001). CONCLUSIONS: With the lack of strong prognostic indicators for DDH identified to date, the center is an important variable to include as a potential predictor of treatment success or failure.
Asunto(s)
Disparidades en Atención de Salud , Luxación Congénita de la Cadera/epidemiología , Articulación de la Cadera/anomalías , Pautas de la Práctica en Medicina , Proyectos de Investigación , Factores de Edad , Australia/epidemiología , Presentación de Nalgas , Canadá/epidemiología , Distribución de Chi-Cuadrado , Femenino , Luxación Congénita de la Cadera/diagnóstico , Luxación Congénita de la Cadera/fisiopatología , Luxación Congénita de la Cadera/terapia , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiopatología , Humanos , Lactante , Recién Nacido , Masculino , México/epidemiología , Oportunidad Relativa , Selección de Paciente , Valor Predictivo de las Pruebas , Embarazo , Estudios Prospectivos , Radiografía , Factores de Riesgo , Tamaño de la Muestra , Índice de Severidad de la Enfermedad , Férulas (Fijadores) , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía , Reino Unido/epidemiología , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Femoroacetabular impingement is increasingly recognized as a cause of hip pain but its incidence after an innominate osteotomy for the correction of acetabular dysplasia has not been determined. This information would be essential for the orthopaedic surgeon because it has the potential to produce a poor outcome in the long term when trying to balance acetabular instability and overcorrection. QUESTIONS/PURPOSES: The purposes of our study were (1) to determine the frequency with which clinically relevant femoroacetabular impingement (FAI) occurs after an innominate osteotomy for the treatment of acetabular dysplasia; (2) to determine risk factors for the development of FAI; and (3) to compare postoperative radiographic and clinical outcomes in patients having undergone an innominate osteotomy for the correction of acetabular dysplasia both with and without FAI. METHODS: This was a retrospective review of 154 hips (132 patients) that had undergone an innominate osteotomy for acetabular dysplasia and were evaluated at a minimum followup of 10 years (mean = 12 years). Mean age at the time of surgery was 3 years, 114 hips had a concomitant open reduction, and 54 hips also had femoral shortening. One hundred eight hips had a Salter osteotomy and 46 had a Pemberton osteotomy. Radiographs were analyzed to determine the lateral center-edge angle (CE angle) and the presence of a crossover sign. The diagnosis of FAI was established when the CE angle was greater than 40°, there was a positive crossover sign, and the patient had groin pain when flexing the hip less than 90°. Comparisons between nonparametric variables were performed with a Mann-Whitney's U test. Categorical variables were compared with a chi-square test. Change in acetabular index (correction) was dichotomized considering 20° of correction as the cutoff point. Association is presented as odds ratio (95% confidence interval), and logistic regression was performed. RESULTS: According to our criteria, 18 of 154 hips had FAI (12%). Of the 18 patients with FAI, 10 had undergone a Pemberton osteotomy (10 of 46 [22%]) and eight a Salter osteotomy (eight of 108 [7%]). A change in the postoperative acetabular index greater than 20° was associated with a greater likelihood of developing FAI. The mean postoperative acetabular index was lower for the group with FAI, for whom it was 20°, compared with the group without FAI, for whom it was 27° (p = 0.04). The mean Iowa Hip Score for the group with FAI was 85, whereas for those without FAI, it was 93 (p = 0.03). CONCLUSIONS: FAI is not common after an innominate osteotomy for the treatment of acetabular dysplasia; however, overcorrection is related to a higher incidence. When FAI is present, it can affect the outcome. Overcorrection should be avoided when performing an innominate osteotomy for the treatment of acetabular dysplasia because it can create iatrogenic FAI and have an adverse effect on outcome. LEVEL OF EVIDENCE: Level III, therapeutic study.
Asunto(s)
Acetábulo/cirugía , Pinzamiento Femoroacetabular/etiología , Luxación Congénita de la Cadera/cirugía , Articulación de la Cadera/cirugía , Enfermedad Iatrogénica , Osteotomía/efectos adversos , Acetábulo/anomalías , Acetábulo/diagnóstico por imagen , Acetábulo/fisiopatología , Fenómenos Biomecánicos , Distribución de Chi-Cuadrado , Niño , Preescolar , Femenino , Pinzamiento Femoroacetabular/diagnóstico , Pinzamiento Femoroacetabular/fisiopatología , Luxación Congénita de la Cadera/complicaciones , Luxación Congénita de la Cadera/diagnóstico , Luxación Congénita de la Cadera/fisiopatología , Articulación de la Cadera/anomalías , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiopatología , Humanos , Lactante , Modelos Logísticos , Masculino , Oportunidad Relativa , Osteotomía/métodos , Radiografía , Rango del Movimiento Articular , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Redislocation after an open reduction for develpmental dislocation of the hip is relatively common. The purpose of this study was to determine if the use of a transarticular pin (TAP) is safe and effective in maintaining reduction. METHODS: A total of 578 patients (645 hips) were reviewed after an open reduction, mean age at the time of surgery was 2.1 years. In 621 cases a smooth Kirschner wire was placed across the joint. The rates of redislocation, avascular necrosis (AVN), and other complications were determined. AVN was classified according to Kalamchi et al. Outcome was determined at a minimum of 6 years using the Severin classification. RESULTS: Redislocation occurred in 27 cases (4.1% rate), 24 had a TAP (3.8%) and 3 did not (12.5%). AVN was observed in 127 cases (19.7%), it was type I in 73 cases, type II in 38 cases, type III in 14 cases, and type IV in 2 cases; AVN was seen in 123 cases which had a TAP (19.8%) and 4 cases which did not (16.7%). Analyzing pin placement: when it was in the inferior third of the neck the rate of AVN was 15.2% (32/211), in the middle third it was 21.7% (71/326), and in the superior third it was 28.6% (24/84). According to the Severin classification for the hips with a TAP, 496 were type I or II (79.8%), 113 were type III (18.2%), 10 were type IV (1.6%), and 2 were type V (0.3%); in the group without a TAP 19 cases were type I or II (79.2%), 4 were type III (16.7%), and 1 was type IV. CONCLUSIONS: The use of a TAP was effective in maintaining reduction and was not associated with significant morbidity. Placing the pin in the inferior third of the neck was associated with the lowest rate of AVN. LEVEL OF EVIDENCE: Level IV--therapeutic.
Asunto(s)
Necrosis de la Cabeza Femoral , Luxación Congénita de la Cadera , Procedimientos Ortopédicos , Osteonecrosis , Complicaciones Posoperatorias/diagnóstico , Clavos Ortopédicos , Preescolar , Femenino , Necrosis de la Cabeza Femoral/diagnóstico , Necrosis de la Cabeza Femoral/etiología , Luxación Congénita de la Cadera/diagnóstico , Luxación Congénita de la Cadera/cirugía , Humanos , Masculino , México , Procedimientos Ortopédicos/efectos adversos , Procedimientos Ortopédicos/instrumentación , Procedimientos Ortopédicos/métodos , Osteonecrosis/diagnóstico , Osteonecrosis/etiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To establish clinical diagnostic criteria for developmental dysplasia of the hip (DDH) that model the practices of expert clinicians. STUDY DESIGN: Of 23 clinical criteria for the diagnosis of DDH, ranked in order of diagnostic importance by international consensus, the 7 most highly ranked were placed in all possible combinations to create unique case vignettes. Twenty-six experts rated 52 vignettes for the presence of DDH. We modeled the data to determine which of the 7 criteria were associated with a clinician's opinion that the vignette represented DDH. From the resulting regression coefficients, for each vignette we calculated a probability of DDH. An independent panel rated the same vignettes using a visual analog scale response. We correlated the visual analog scale ratings with probabilities derived from the model. RESULTS: Our model identified 4 of 7 criteria as predictive of DDH (P < .001): Ortolani/Barlow test (ß = 3.26), limited abduction (ß = 1.48), leg length discrepancy (ß = 0.74), and first-degree family history of DDH (ß = 1.39). There was substantial correlation between the probability of DDH predicted by the model and that derived from an independent expert panel (r = 0.73; P < .001). CONCLUSION: Weighted clinical criteria for inferring the likelihood of DDH produced consistent results in the judgment of 2 separate groups of experts. Using these weights, nonexperts could establish the probability of DDH in a manner approaching the practice of clinical experts.
Asunto(s)
Luxación Congénita de la Cadera/diagnóstico , Adulto , Técnica Delphi , Femenino , Luxación Congénita de la Cadera/diagnóstico por imagen , Articulación de la Cadera/diagnóstico por imagen , Humanos , Masculino , Dimensión del Dolor , Reproducibilidad de los Resultados , UltrasonografíaRESUMEN
Por más de una década, la férula en abducción de cadera ha sido el método de tratamiento del desarrollo displásico de caderas, en el Hospital Pediátrico Universitario Paquito González Cueto de Cienfuegos. El objetivo de este trabajo es exponer la clasificación dinámica para las caderas con desarrollo displásico, desde el punto de vista radiográfico. Para ilustrar la clasificación se utilizaron esquemas representativos y radiografías de pacientes portadores de diferentes grados de la afección. El comportamiento dinámico de los parámetros radiográficos utilizados en la clasificación, permite realizar agrupaciones diagnósticas antes, durante y después del tratamiento, en función de evaluar los resultados finales de este(AU)
For over a decade, abduction splinting has been the method of treatment for developmental dysplasia of the hip in the Paquito González Cueto University Pediatric Hospital. This paper is aimed at presenting the dynamic classification for this condition from a radiographic point of view. Representative schemes and radiographies of patients with various stages of developmental hip dysplasia were used for illustrating this classification. The dynamic behavior of the radiographic parameters used in the classification allows gathering diagnostic groups before, during and after treatment in order to assess its final results(AU)
Asunto(s)
Humanos , Lactante , Luxación Congénita de la Cadera/diagnóstico , Luxación Congénita de la Cadera , Luxación Congénita de la Cadera/terapia , Clasificación/métodos , Evaluación de Procesos y Resultados en Atención de Salud , FerulaRESUMEN
The developmental dysplasia of the hip (DDH), where the spectrum of deformity varies from a slight mismatch in the articular surfaces between the ilium and femur, which will bring a premature wear of the joint, until the situation more serious when the femoral head is out of the acetabulum, causing a host of disorders side as curvature of the spine, significant shortening of the limb deformities in the knee and the contralateral hip, as well as causing pain and loss of joint mobility mentioned. All this makes the spectrum of abnormalities in a person being disabled with a social and economic burden for the family and society. "Preventing" a clinical entity such as developmental dysplasia of the hip does not mean to anticipate the presentation, because children continue to be born with this problem, but to have a program for early detection and early treatment and thus prevent the occurrence. The goal of this study was to provide the medical community that timely tool for prevention. When diagnosed and treated in a timely and favorable prognosis qualified for motor function and quality of life.
Asunto(s)
Luxación Congénita de la Cadera/diagnóstico , Consenso , Diagnóstico Precoz , Femenino , Luxación Congénita de la Cadera/diagnóstico por imagen , Luxación Congénita de la Cadera/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Prevalencia , Radiografía , Reproducibilidad de los ResultadosRESUMEN
Antecedentes: la dispasia de desarrollo de la cadera constituye un problema incapacitante en la ortopedia infantil. se investigó los hallazgos clínicos, radiológicos y medidas terapéuticas en niños menores de 5 años de edad con el fin de encontrar mayor información sobre la realidad de dichapatología en el Perú. Métodos: se realizó un estudio descriptivo y retrospectivo mediante la revisión de 165 historias clínicas de niños con diagnóstico de Displasia de desarrollo de la cadera correspondientes periodo 1 de Enero del 2004 al 31 de Diciembre del 2006, proporcionadas por la Oficina de Estadística e Informática del Instituto Nacional de Salud del Niño - Lima Perú. Resultados: Un total de 165 pacientes (73,9 por ciento de sexo femenino)fueron incluidos. No referían antecedentes familiares 95 pacientes (57,6 por ciento) sesenta y nueve pacientes (47,9 por ciento) tuvieron parto eutócico. Ochenta y tres pacientes (50,3 por ciento) fueron normopeso. La articulación coxofemoral izquierda estuvo comprometida en 78 pacientes (47,3 por ciento), evidenciandose en 111 pacientes (78,2 por ciento) limitación de abducción. El diagnóstico inagenológico fue por radiografía en 114 pacientes (69,1 por ciento), siendo la edad más frecuente lactante menor en 140 pacientes (84,8 por ciento). El tratamiento médico más utilizado fue Arnés de Pavlik en 36 pacientes (21,8 por ciento), no recibiendo tratamiento quirúrgico 117 pacientes (70,95 por ciento). La evolución clínica favorable en 114 pacientes (69,1 por ciento). Conclusiones: La mayoria de pacientes con displasia de desarrollo de la cadera fueron lactantes menores de sexo femenino, presentando la articulación coxofemoral izquierda comprometida y limitación a la abducción como hallazgo primario. El diagnósticofue preferentemente por radiografía, recibiendo tratamiento médico con una evolución favorable
Background. Developmental dysplasia of the hip is a disabling problem in children's orthopedics. We investigated the clinical, radiological and therapeutic findings in children under 5 years old in order tofind out further about the reality in Perú. Methods: We preformed a retrospective descriptive study through reviewing of 165 medical records for the period January 1, 2004 to December 31, 2006, provided by Ofinina de Estadídtica e Informática of Instituto Nacional de Salud del Niño-Lima, Perú. Results: a total of 165 patients (73.9 por ciento female)were included. Family history was not referred by 95 patients (57.6 per cent). Seventy-nine patients (47.9 per cent) had vaginal delivery in cephalic presentation. Eighty-three patients (50.3 per cent)had normal birth weight. The left hip joint was affected in 78 patients (47.3 per cent) and 111 patients (78.2 per cent) had limitation of abduction. the diagnosis was by radiographic imaging in 114 patients(69.1 per cent), being the most frequnet age in 140 patients (84.8) `young infantd. The most widely used medical treatment was Pavlik harness in patients (21.8 per cent), and 117 patients (70.95 per cent) did not receive surgical treatment. Clinical evolution was favorable in 114 patients (69.1 per cent). Conclusion: Most patients with developmental dysplasia of the hip were young female infants, having the left hip joint affected and limitation of abduction. The diagnosis was mainly by radiographic,receiving treatment with favorable results