Introduction: While bracing may improve the natural history of patients with adolescent idiopathic scoliosis with moderate curves, little attention has been paid to the potential impact of brace treatment on their quality of life. We hypothesized that bracing has a negative affect on the physical and psychosocial health of affected adolescents.

Methods: Quality of life (QOL) data was collected from patients with adolescent idiopathic scoliosis and a spinal curvature greater than 10 degrees at our institution. The Child Health Questionnaire (CHQ) and the American Academy of Orthopaedic Surgeons Pediatric Outcomes Data Collection Instrument (PODCI) were administered to parents to measure their children’s QOL. Multivariate analyses were conducted to determine the effect of gender and treatment on QOL.

Results: Our cohort consisted of 214 patients, who were mostly female, with an average curve of 28 degrees and an average age of 13.7 years. One hundred thirty four patients were observed (average curve 25 degrees), while 80 patients were treated with bracing (average curve 34 degrees). There were no significant differences in QOL between these two treatment groups, using the Bonfer-roni multiple comparison test. There were no gender-related differences in QOL. Among 15 children with pre- and intra-bracing data, there were no significant differences in QOL between these two time points.

Discussion and conclusion: Our patients who were treated with spinal bracing did not seem to have significantly different health-related QOL, as compared with patients in the observation group. These findings are contrary to our initial hypotheses and merit further study.

Introduction: The goal of surgical equalization of leg length discrepancy (LLD) is to improve the quality of life (QOL) of affected individuals by improving function and appearance. While many surgeons utilize a cut off point of 2cm as a treatment guide, little attention has been focused on the effect of LLD on QOL. The purpose is to determine the critical cut off size for the effect of LLD on QOL. Such information may help refine the surgical indications of leg length equalization in these patients.

Methods: QOL and scanogram data were collected from children diagnosed with LLD at our institution. QOL was assessed using the parent short-form of the Child Health Questionnaire (CHQ). QOL scores from this group were compared to normative data. Correlation analyses and independent t-tests were conducted to assess the relationship between size of LLD and QOL.

Results: Our cohort consists of 41 patients (50 observations) with an average LLD of 2.05cm. Compared to norms, LLD patients scored significantly lower on four CHQ domains. Correlation analyses revealed a negative relationship between size of LLD and several psychosocial domains. Independent t-test revealed that children with LLD greater than or equal to 2cm scored significantly (p< 0.05) higher in six domains than children with LLD> 2cm: General Health, Parental Impact-Emotional Scale, Parental Impact-Time Scale, Family Activities, Family Cohesion, Psychosocial Summary Score.

Discussion and conclusion: With increasing LLD, differences in psychosocial health become especially apparent. This study suggests that children with LLD> 2 cm experience perturbations in QOL, supporting the use of this cut off as a guideline for intervention.

Almost one child in twenty with trisomy 21 will develop spontaneous dislocation of the hip between learning to walk and the age of 10 years. After the age of two years spontaneous habitual dislocation may occur. If left untreated, acute dislocation, subluxation and fixed dislocation follow in sequence. The natural history of the condition is described and the clinical and radiological features of 45 dislocations in 28 patients are presented. Nineteen had received no treatment. The most effective treatment was found to be pelvic or femoral osteotomy, combined with capsular plication, carried out in the phase of habitual dislocation. Once subluxation or fixed dislocation was present, the results of operation were poor and it is not recommended. All patients, even if left untreated, remain mobile. Pain is not a prominent feature.