To evaluate the safety and efficacy of treating patients with Graf IIa developmental hip dysplasia. The management of the developmentally immature Graf Type IIa dysplastic hip is controversial. Some authors advocate early treatment with an abduction harness whilst others adopt watchful waiting. At our institution selective sonographic assessment for developmental dysplasia of the hip (DDH) was established in 1997 with prospective data collection. All infants diagnosed with Graf Type IIa hip(s) were treated with either a Pavlik harness or double nappies, with clinical and sonographic follow up until normalisation. Pelvic radiographs were routinely performed at 8 and 18 months follow up for assessment of residual dysplasia and/or complications of treatment. We evaluated the safety and efficacy of all treated patients between 2005 and 2013. Complete clinical and radiological follow up (mean 2.1 years, 0.7–6.5) was available for 103 of 118 infants. 69 were treated with a Pavlik harness and 49 with double nappies. The chosen treatment was successful in 110 hips with no documented complications, well developed ossific nuclei on follow up radiographs, and no further treatments undertaken. In the double nappy group 4 infants deteriorated sonographically so were changed to a Pavlik harness with subsequent normalisation and successful treatment. 3 patients required VDRO at age 18 months (17–20) and 1 patient required closed reduction and spica cast treatment at age 11 months. No further complications arose in this group. The 15 patients lost to follow up had successful initial treatment but failed to attend for radiographic review. Both Pavlik harness and double nappies are safe treatment modalities for Type IIa hip dysplasia. However, sonographic deterioration was observed in both groups with surgical intervention required in the minority, supporting the ongoing treatment of these immature hips

Aims

Perthes’ disease is a condition leading to necrosis of the femoral head. It is most common in children aged four to nine years, affecting around one per 1,200 children in the UK. Management typically includes non-surgical treatment options, such as physiotherapy with/without surgical intervention. However, there is significant variation in care with no consensus on the most effective treatment option.

The management of children’s fractures has evolved as a result of better health education, changes in lifestyle, improved implant technology and the changing expectations of society. This review focuses on the changes seen in paediatric fractures, including epidemiology, the increasing problems of obesity, the mechanisms of injury, non-accidental injuries and litigation. We also examine the changes in the management of fractures at three specific sites: the supracondylar humerus, femoral shaft and forearm. There has been an increasing trend towards surgical stabilisation of these fractures. The reasons for this are multifactorial, including societal expectations of a perfect result and reduced hospital stay. Reduced hospital stay is beneficial to the social, educational and psychological needs of the child and beneficial to society as a whole, due to reduced costs.

Cite this article: Bone Joint J 2015; 97-B:442–8.