Within healthcare, several measures are used to quantify and compare the severity of health conditions. Two common measures are disability weight (DW), a context-independent value representing severity of a health state, and utility weight (UW), a context-dependent measure of health-related quality of life. Neither of these measures have previously been determined for developmental dysplasia of the hip (DDH). The aim of this study is to determine the DW and country-specific UWs for DDH. A survey was created using three different methods to estimate the DW: a preference ranking exercise, time trade-off exercise, and visual analogue scale (VAS). Participants were fully licensed orthopaedic surgeons who were contacted through national and international orthopaedic organizations. A global DW was calculated using a random effects model through an inverse-variance approach. A UW was calculated for each country as one minus the country-specific DW composed of the time trade-off exercise and VAS.Aims
Methods
Although atlantoaxial rotatory fixation (AARF) is a common cause
of torticollis in children, the diagnosis may be delayed. The condition
is characterised by a lack of rotation at the atlantoaxial joint
which becomes fixed in a rotated and subluxed position. The management of
children with a delayed presentation of this condition is controversial.
This is a retrospective study of a group of such children. Children who were admitted to two institutions between 1988 and
2014 with a diagnosis of AARF were included. We identified 12 children
(four boys, eight girls), with a mean age of 7.3 years (1.5 to 13.4),
in whom the duration of symptoms on presentation was at least four weeks
(four to 39). All were treated with halo traction followed by a
period of cervical immobilisation in a halo vest or a Minerva jacket.
We describe a simple modification to the halo traction that allows
the child to move their head whilst maintaining traction. The mean follow-up
was 59.6 weeks (24 to 156).Aims
Patients and Methods
Fractures of the odontoid in children with an open basilar synchondrosis differ from those which occur in older children and adults. We have reviewed the morphology of these fractures and present a classification system for them. There were four distinct patterns of fracture (types IA to IC and type II) which were distinguished by the site of the fracture, the degree of displacement and the presence or absence of atlantoaxial dislocation. Children with a closed synchondrosis were classified using the system devised by Anderson and D’Alonzo. Those with an open synchondrosis had a comparatively lower incidence of traumatic brain injury, a higher rate of missed diagnosis and a shorter mean stay in hospital. Certain subtypes (type IA and type II) are likely to be missed on plain radiographs and therefore more advanced imaging is recommended. We suggest staged treatment with initial stabilisation in a Halo body jacket and early fusion for those with unstable injuries, severe displacement or neurological involvement.
