The value of preliminary traction in the treatment of congenital dislocation of the hip.

In forty-one children who had forty-seven congenitally dislocated hips, the results of attempted closed reduction with general anesthesia, but without preliminary traction, were studied. Twenty (43 per cent) of the hips could not be reduced closed, and an open reduction was needed. After the reduction, all of the involved hips were immobilized in the so-called human position (marked flexion and slight abduction). At a minimum follow-up of two years, osteonecrosis of the femoral head had developed in only two hips (4 per cent). Patients who were more than one year old when the hip was reduced had a higher incidence of osteonecrosis of the femoral head and were more likely to need reconstructive procedures later. Patients who were more than eighteen months old at the time of the attempted closed reduction were more likely to need an open reduction of the hip. Treatment of congenital dislocation of the hip in young children remains an extremely complex problem. It has not been clearly established that the use of preliminary traction decreases the incidence of osteonecrosis of the femoral head or improves the outcome of treatment. In our experience, uncomplicated (non-teratological, postnatal) congenital dislocation of the hip has been safely treated with either open or closed reduction without preliminary traction in patients who were younger than two years old, provided that the reduction could be obtained without excessive force.

[Diagnostic value of sonography and double contrast arthrography in meniscus lesions]. / Diagnostische Wertigkeit von Sonographie und Doppelkontrastarthrographie bei Meniskusläsionen.

Using a real time scanner and a 7.5 mHz transducer, the meniscus can bei visualised as a homogeneous triangle. It is clearly distinguishable from the tibial plane und the condyle of the femur. Tears in the meniscus show up as a double contour rich in echoes with an intervening low-echo area, or as a contour rich in echoes with an adjacent low-echo area. The posterior horn area can be visualised most clearly. Assessment of the interior part of the meniscus is somewhat easier than visualising the exterior part. In a clinical study with 107 menisci examined by sonography and controlled by arthroscopy or arthrotomy the rate of accurate diagnoses by sonography of the meniscus is 82%. 42 of these menisci were additionally examined by double contrast arthrography besides sonography. This yielded an accuracy rate of 74% for double contrast arthrography; the latter is superior to sonography only in the anterior horn area. Problems in respect of meniscus sonography occur only in case of transverse ruptures, scars and longitudinal meniscus ruptures presenting as bucket handle tears near the base. The typical longitudinal tear in the area of the posterior horn can be visualised most clearly. Analysis of the results shows that sonography of the meniscus is a noninvasive, painless and randomly reproducible and risk-free examination method which has a diagnostic value especially in the area of the posterior horn that can be compared with double contrast arthrography. Further studies must show whether with an increasing spread of the method it would be possible to replace double contrast arthrography by sonography in diagnosis of menisceal trouble.

The case against routine metal removal.

Metal removal is one of the most commonly performed operations in pediatric orthopedics. Many of these operations are performed electively in asymptomatic patients. In a retrospective study of 138 patients who had metal removal operations, the indication for surgery was uncomplicated healing in 69%. The overall complication rate was 13%, including incomplete removal in 7% and refracture in 1.4% after metal removal. Operations to remove metal from the proximal femur were associated with the highest complication rates, especially in patients with slipped capital femoral epiphysis. In a comparison of the risks associated with metal removal operations and the risks of long-term metal retention, little evidence was found to support a policy of routinely removing asymptomatic implants after the completion of bone healing.

[The instant formulated parenteral solution Fresubin in the postoperative feeding of patients after maxillofacial surgery]. / Die Sondenfertignahrung Fresubin bei der postoperativen Ernährung kieferchirurgischer Patienten.

21 patients who underwent maxillofacial surgery received daily 6-8 packets of the instant formula diet Fresubin (2,100-2,800 kcal = 8,790-11,720 J). In 1 patient nutrition with Fresubin had to be interrupted due to vomiting. Under nutrition with Fresubin, mean body weight decreased significantly by about 3.5 kg. Serum electrolytes, blood gases, pH, base excess, serum-urea-nitrogen and creatinine, albumin content, serum transaminases, glucose content, hemoglobin and hematocrit did not show any significant change. It was evident that the sodium and potassium content of Fresubin was not high enough to guarantee normal serum values. In 8 of 21 patients potassium had to be substituted parenterally. Concentrations of lipids and triglycerids increased during nutrition with Fresubin and became elevated over normal values without statistic significance.

The value of the acetabular teardrop figure in assessing pediatric hip disorders.

We have observed that the acetabular teardrop figure provides extremely useful information about the development of the hip in young children. Normal development of the acetabulum is associated with progressive narrowing of the teardrop figure and development of a concave shape to its acetabular line. Anatomic and functional abnormalities of the hip can cause abnormalities of the teardrop figure, including absence of the acetabular line, persistent widening, and a V-shaped teardrop figure. In young children, these abnormalities can be reversed to some degree by stabilizing operations, but it is unusual to observe substantial change in appearance of the teardrop figure after a child is aged 8 years.