To identify the incidence of sequential slip of the unaffected hips in patients presenting with unilateral SCFE managed with prophylactic fixation or observation. A retrospective review of all unilateral SCFE treated during 1998 to 2012 was undertaken. The study compares the incidence of sequential slip of the initially unaffected hip in patients managed with prophylactic fixation or observation. The study also reports the incidence avascular necrosis, chondrolysis, and metal-work related problem in this group of patients. All patients included in this current work have at least 12 months of follow-up from the index slip. A total of 44 cases had prophylactic fixation of the unaffected hip (mean age 12.6 years,) and 36 patients managed with regular observation (mean age 13.4 years). Sequential slip of the unaffected hip was noted in a total of 10 patients (28 %) managed with regular observation and only in 1 patient (2%) managed with prophylactic fixation. A Fishers exact test showed significantly high incidence of sequential slip in unaffected hips when managed by regular observation (p-value-0.002). There is no evidence of avascular necrosis or chondrolysis in the unaffected hip in both groups, 3 patients had metalwork related problem and one had superficial wound infection in prophylactic fixation group. Simultaneous prophylactic fixation of the unaffected hips significantly reduces the incidence of sequential slip. This is a relatively safe procedure and should be advocated in all cases of unilateral SCFE to avoid potential complications and preserve function of the unaffected hip.
We undertook a randomised clinical trial to compare
treatment times and failure rates between above- and below-knee
Ponseti casting groups. Eligible children with idiopathic clubfoot,
treated using the Ponseti method, were randomised to either below-
or above-knee plaster of Paris casting. Outcome measures were total
treatment time and the occurrence of failure, defined as two slippages
or a treatment time above eight weeks. A total of 26 children (33 feet) were entered into the trial.
The above-knee group comprised 17 feet in 13 children (ten boys
and three girls, median age 13 days (1 to 40)) and the below-knee
group comprised 16 feet in 13 children (ten boys and three girls,
median age 13 days (5 to 20)). Because of six failures (37.5%) in
the below-knee group, the trial was stopped early for ethical reasons.
The rate of failure was significantly higher in the below-knee group
(p = 0.039). The median treatment times of six weeks in the below-knee
and four weeks in the above-knee group differed significantly (p
= 0.01). This study demonstrates that the use of a below-knee plaster
of Paris cast in conjunction with the Ponseti technique leads to
unacceptably high failure rates and significantly longer treatment
times. Therefore, this technique is not recommended. Cite this article:
We present a case of late dislocation of the hip in a 30-month-old girl. Her hip was clinically stable at birth and an ultrasound scan at six weeks was normal. She had no additional risk factors for developmental dysplasia. She underwent anterior open reduction with a femoral osteotomy.
