The aim of this study was to investigate the agreement in interpretation of the quality of the paediatric hip ultrasound examination, the reliability of geometric and morphological assessment, and the relationship between these measurements. Four investigators evaluated 60 hip ultrasounds and assessed their quality based the standard plane of Graf et al. They measured geometric parameters, described the morphology of the hip, and assigned the Graf grade of dysplasia. They analyzed one self-selected image and one randomly selected image from the ultrasound series, and repeated the process four weeks later. The intra- and interobserver agreement, and correlations between various parameters were analyzed.Aims
Methods
A national screening programme has existed in the UK for the diagnosis of developmental dysplasia of the hip (DDH) since 1969. However, every aspect of screening and treatment remains controversial. Screening programmes throughout the world vary enormously, and in the UK there is significant variation in screening practice and treatment pathways. We report the results of an attempt by the British Society for Children’s Orthopaedic Surgery (BSCOS) to identify a nationwide consensus for the management of DDH in order to unify treatment and suggest an approach for screening. A Delphi consensus study was performed among the membership of BSCOS. Statements were generated by a steering group regarding aspects of the management of DDH in children aged under three months, namely screening and surveillance (15 questions), the technique of ultrasound scanning (eight questions), the initiation of treatment (19 questions), care during treatment with a splint (ten questions), and on quality, governance, and research (eight questions). A two-round Delphi process was used and a consensus document was produced at the final meeting of the steering group.Aims
Methods
The aims of this study were to evaluate the abductor function in moderate and severe slipped capital femoral epiphysis (SCFE), comparing the results of a corrective osteotomy at the base of the femoral neck and osteoplasty with 1) A total of 24 patients (mean age 14.9 years (Aims
Patients and Methods
The aim of this study was to determine whether
an osteoplasty of the femoral neck performed at the same time as an
intertrochanteric Imhäuser osteotomy led to an improved functional
outcome or increased morbidity. A total of 20 hips in 19 patients
(12 left, 8 right, 13 male, 6 female), who underwent an Imhäuser
intertrochanteric osteotomy following a slipped capital femoral
epiphysis were assessed over an eight-year period. A total of 13
hips in 13 patients had an osteoplasty of the femoral neck at the
same time. The remaining six patients (seven hips) had intertrochanteric
osteotomy alone. The mean age was 15.3 years (13 to 20) with a mean
follow-up of 57.8 months (15 to 117); 19 of the slips were severe
(Southwick grade III) and one was moderate (grade II), with a mean
slip angle of 65.3° (50° to 80°); 17 of the slips were stable and
three unstable at initial presentation. The mean Non-Arthritic Hip Scores
(NAHS) in patients who underwent osteoplasty was 91.7 (76.3 to 100)
and the mean NAHS in patients who did not undergo osteoplasty was
76.6 (41.3 to 100) (p = 0.056). Two patients required a subsequent
arthroplasty and neither of these patients had an osteoplasty. No
hips developed osteonecrosis or chondrolysis, and there was no increase
in complications related to the osteoplasty. We recommend that for
patients with a slipped upper femoral epiphysis undergoing an intertrochanteric
osteotomy, the addition of an osteoplasty of the femoral neck should
be considered. Cite this article:
In late developmental dysplasia of the hip in childhood, the deformed dysplastic acetabulum is malaligned and has lost its shape due to pressure from the subluxed femoral head. The outer part of the acetabulum involves the upper part of the original acetabulum, thereby giving a bipartite appearance. A clear edge separates the outer from inner part which represents the lower part of the original acetabulum and has no direct contact with the femoral head. Combined pelvic osteotomy (CPO) using a Lance acetabuloplasty with either a Salter or a Pemberton procedure restores the original shape and realigns the acetabulum. A total of 20 children (22 hips), with a mean age of 46 months (28 to 94) at primary operation underwent CPO with follow-up for between 12 and 132 months. In each case concentric stable reduction with good acetabular cover was achieved and maintained throughout the period of follow-up.
Our aim was to determine whether abnormalities noted on MRI immediately after reduction for developmental dysplasia of the hip could predict the persistance of dysplasia and aid surgical planning. Scans of 13 hips in which acetabular dysplasia had resolved by the age of four years were compared with those of five which had required pelvic osteotomy for persisting dysplasia. The scans were analysed by two consultant musculoskeletal radiologists who were blinded to the outcome in each child. The postreduction scans highlighted a number of anatomical abnormalities secondary to developmental dysplasia of the hip, but statistical analysis showed that none were predictive of persisting acetabular dysplasia in the older child, suggesting that the factors which determine the long-term outcome were not visible on these images.
