The safety and efficacy of a transarticular pin for maintaining reduction in patients with developmental dislocation of the hip undergoing an open reduction.

BACKGROUND: Redislocation after an open reduction for develpmental dislocation of the hip is relatively common. The purpose of this study was to determine if the use of a transarticular pin (TAP) is safe and effective in maintaining reduction. METHODS: A total of 578 patients (645 hips) were reviewed after an open reduction, mean age at the time of surgery was 2.1 years. In 621 cases a smooth Kirschner wire was placed across the joint. The rates of redislocation, avascular necrosis (AVN), and other complications were determined. AVN was classified according to Kalamchi et al. Outcome was determined at a minimum of 6 years using the Severin classification. RESULTS: Redislocation occurred in 27 cases (4.1% rate), 24 had a TAP (3.8%) and 3 did not (12.5%). AVN was observed in 127 cases (19.7%), it was type I in 73 cases, type II in 38 cases, type III in 14 cases, and type IV in 2 cases; AVN was seen in 123 cases which had a TAP (19.8%) and 4 cases which did not (16.7%). Analyzing pin placement: when it was in the inferior third of the neck the rate of AVN was 15.2% (32/211), in the middle third it was 21.7% (71/326), and in the superior third it was 28.6% (24/84). According to the Severin classification for the hips with a TAP, 496 were type I or II (79.8%), 113 were type III (18.2%), 10 were type IV (1.6%), and 2 were type V (0.3%); in the group without a TAP 19 cases were type I or II (79.2%), 4 were type III (16.7%), and 1 was type IV. CONCLUSIONS: The use of a TAP was effective in maintaining reduction and was not associated with significant morbidity. Placing the pin in the inferior third of the neck was associated with the lowest rate of AVN. LEVEL OF EVIDENCE: Level IV--therapeutic.

Do the Functional Results of Surgical Treatment of Patients with Neglected Developmentally Dislocated Hips Remain the Same with Longer Follow-Up?

BACKGROUND: The results of treatment for neglected developmental dysplasia of the hips (DDH) in children remains controversial. We sought to determine the clinical and radiographic result of patients with neglected DDH with special emphasis on the functional outcome as determined by the Pediatric Outcomes Data Collection Instrument (PODCI) and determine which preoperative variables were related to the result. We also sought to determine if the functional results remain the same over time and if there is there a preoperative variable that can predict a poor outcome. METHODS: This was a retrospective review of 15 patients (19 hips, 11 unilateral and 4 bilateral) treated after the age of 6 years (mean: 7.6 years) with one stage open reduction, femoral shortening, and innominate osteotomy with a minimum follow-up of 15 years. Clinical and radiographic evaluations were performed at 10 years and 15 years after the index procedure. Functional outcome was determined using the PODCI scale and the Iowa Hip Score; the radiographic result was evaluated with the Severin classification, the center-edge angle, and the Tönnis grade of osteoarthritis. Linear regression analysis was used to determine the influence of preoperative variables on the result. RESULTS: The patients were evaluated at two points in time: the first evaluation was performed at a mean 10.7 years after surgery (range: 10.0 to 12.2 years); at that time, the patients mean age was 17.8 years; 11 had pain and 14 had a limp, the mean Iowa hip score was 73.5 and the mean PODCI score was 88.05. The mean CE angle was 26.9°, one hip was considered a Severin type I, six as type II, eight as type III, and four as type IV; eight hips were considered Tönnis grade I, seven grade II, and four grade III. The second evaluation was performed at a mean 15.8 years after surgery (range: 15.1 to 17.3 years); at that time, the patients mean age was 22.9 years; 14 had pain and 14 had a limp, the mean Iowa hip score was 67.8, and the mean PODCI score was 85.73. The mean CE angle was 29.7°, one hip was considered a Severin type I, four as type II, 10 as type III, and four as type IV; two hips were considered Tönnis grade I, five grade II, nine grade III, and three grade IV. The results were significantly worse than those seen at the first evaluation. Linear regression analysis showed a tendency toward worse functional and radiographic results with increasing age at the time of treatment as well as with time of follow-up. CONCLUSIONS: The results demonstrate a directly inverse relationship between age at the time of treatment and functional and radiographic results for patients with neglected DDH. A progressive deterioration of the results with further follow-up was also found.

Functional outcome of stable grade III slipped capital femoral epiphysis treated with in situ pinning.

BACKGROUND: We sought to determine the functional outcome of patients with grade 3 slipped capital femoral epiphysis who had been treated with in situ pinning at a mid-term follow-up. METHODS: One hundred and five patients with 129 slips (24 bilateral) were reviewed. Minimum follow-up was 5 years and mean follow-up was 66 months. Slips over 60 degrees were considered grade 3. All of the patients underwent in situ pinning with a single cannulated screw; the placement of the screw was evaluated with the criteria of Stambough. The final evaluation was performed using the Iowa Hip Score and results were analyzed by sex, age at time of diagnosis, and body mass index. Statistical analysis was carried out using the Mann-Whitney U-test considering a P value of less than 0.005 to be statistically significant. RESULTS: The mean Iowa Hip Score was 84.73. Fifty-two patients were considered to have an excellent result, 28 a good result, 16 a fair result, and 9 a bad result. The pin placement was considered adequate in 89 patients and inadequate in 16 patients. Forty-three patients were girls and 62 were boys and no statistical difference was found in function by sex. The mean Iowa Hip Score for patients under 12 years of age (n=20) was 85.8, for those between 12 and 15 years of age (n=69) it was 82.8 and for those over 15 years of age (n=16) it was 82.5 (P=0.003). There were 10 complications, all in the group in which the pin placement was considered inadequate, and all of these were considered fair or poor results. CONCLUSIONS: The functional results in the mid-term for patients with grade 3 slips treated with in situ pinning were generally good or excellent; a better result was found in patients below 12 years of age. A good or excellent result can be expected when pin placement is adequate and no complications arise.

Varus-producing osteotomy for patients with lateral pillar type B and C Legg-Calvé-Perthes disease followed to skeletal maturity.

PURPOSE: We sought to determine if a varus-producing osteotomy of the proximal femur was related to a better outcome than non-operative treatment for LCP disease. METHODS: This was a retrospective review of 121 patients; clinical outcome was determined with the Iowa Hip Score, and radiographic outcome was determined with the Stulberg classification. RESULTS: A total of 73 patients undergoing a VO and 48 treated non-operatively were included; 70 had lateral pillar type B and 51 type C hips. Average follow-up was 12.03 years. The mean Iowa Hip Score was 86.8 for the VO group and 85.9 for the non-operative group. According to the Stulberg classification for the group undergoing a VO, there were 8 type II, 33 type III, and 32 type III, and for the group undergoing non-operative treatment there were 11 type II, 24 type III, and 13 type IV. CONCLUSIONS: We found no statistically significant difference in the clinical or radiographic result for patients undergoing a VO compared to non-operative treatment.

Tratamiento de la epifisiolistesis femoral proximal mediante tornillo canulado: reporte preliminar / Treatment of the proximal femoral epiphysiolystesis by a canulated screw: preliminary report

En el lapso comprendido de marzo a noviembre de 1991, se trataron 12 pacientes (16 caderas) con el diagnóstico de epifisiolistesis femoral proximal. Siete caderas presentaron deslizamiento grado I; cuatro, grado II; y cinco, grado III. Asimismo predominó el sexo masculino y el lado izquierdo. En cuatro pacientes se manifestó la patología en forma bilateral. Se clasificaron 14 como crónicos y dos como crónicos agudizados. Todos nuestros pacientes fueron tratados en forma quirúrgica mediante la fijación in situ con tornillo canulado mediante control fluoroscópico transoperatorio. A la fecha, los resultados no son concluyentes en tres de nuestros casos, ya que el tiempo portoperatorio es aún corto; del resto, siete pacientes se encuentran asintomáticos, con arcos de movilidad completos y marcha plantígrada e indolora; dos pacientes presentarn limitación en la movilidad y algún tipo de sintomatología. La transfixión intra-articular se presentó en dos casos, los cuales requirieron recolocación y retiro del material de osteosíntesis, respectivamente.

Tratamiento de las discrepancias de los miembros inferiores por el método de epifisiodesis de Phemister / Treatment of lower limbs lenght inequality by the phemister epyphisiodesis

Se evaluaron los caso de 36 niños, a los cuales de les practicó epifisiodesis con la técnica original descrita por Phemister; 12 del sexo femenino y 25 del masculino. La edad promedio fue de 11.3 años; el grupo de menor edad fue el de seis años, y el mayor, es de 15 años. el seguimiento promedio de los pacientes fue a 39.9 meses; el mínimo fue de tres meses en tres casos, los cuales acudieron a una sola evaluación posterior, y el máximo fue de 110 meses. Los resultados se clasificaron en excelentes, de 0 a 10 mm. de discrepancia; buenos, de 11 a 25 mm; regulares de 26 a 40 mm, y malos, de más de 40 mm. Se obtuvo un total de tres (9 por ciento) resultados excelentes, 16 (48 por ciento) buenos, 12 (36 por ciento) regulares y dos (6 por ciento) malos. Las complicaciones que se presentaron fueron cicatriz poco estética en todos los casos; sobrecrecimiento de las extremidades en dos casos; en ninguno se presentaron deformidades angulares