Hip Structural Analysis Reveals Impaired Hip Geometry in Girls With Type 1 Diabetes.

CONTEXT: Among patients with type 1 diabetes (T1D), the risk of hip fracture is up to 6-fold greater than that of the general population. However, the cause of this skeletal fragility remains poorly understood. OBJECTIVE: To assess differences in hip geometry and imaging-based estimates of bone strength between youth with and without T1D using dual-energy x-ray absorptiometry (DXA)-based hip structural analysis. DESIGN: Cross-sectional comparison. PARTICIPANTS: Girls ages 10 to 16 years, including n = 62 with T1D and n = 61 controls. RESULTS: The groups had similar age, bone age, pubertal stage, height, lean mass, and physical activity. Bone mineral density at the femoral neck and total hip did not differ in univariate comparisons but was lower at the femoral neck in T1D after adjusting for bone age, height, and lean mass. Subjects with T1D had significantly lower cross-sectional area, cross-sectional moment of inertia, section modulus, and cortical thickness at the narrow neck, with deficits of 5.7% to 10.3%. Cross-sectional area was also lower at the intertrochanteric region in girls with T1D. Among those T1D subjects with HbA1c greater than the cohort median of 8.5%, deficits in hip geometry and strength estimates were more pronounced. CONCLUSIONS: DXA-based hip structural analysis revealed that girls with T1D have unfavorable geometry and lower estimates of bone strength at the hip, which may contribute to skeletal fragility and excess hip fracture risk in adulthood. Higher average glycemia may exacerbate effects of T1D on hip geometry.

Sport-specific musculoskeletal growth and postural control in female artistic gymnasts: a 12 month cohort study.

Female gymnasts have been evidenced to experience sport-specific growth, of which broad shoulders and narrow hips are common characteristics. In addition to being a central component of handstand performance, postural control mechanisms, including whole-body and lumbo-pelvic stability, have been identified as risk factors for overuse spinal pathology. The study aimed to develop a fundamental understanding of musculoskeletal growth and postural control responses of female artistic gymnasts in order to extend longitudinal insights into overuse spinal pathology risk. Whole-body anthropometric measures were collected for 12 competitive female gymnasts (age at recruitment: nine to 15 years) at three time points across a 12 month period. Musculoskeletal growth was partially defined as the rate of bicristal-to-biacromial breadth ratio development, and informed shoulder- and pelvis-dominant growth sub-groups. Kinematic and kinetic indicators of postural control were determined for a total of 700 handstand trials. The shoulder-dominant (gymnastics-specific) growth group was found to have significantly greater biomechanical risk for general stability (p < 0.001) than the pelvis-dominant group. Significantly greater lumbo-pelvic risk was demonstrated for the pelvis-dominant group (p < 0.001). Extended idiosyncratic examination of proportional sport-specific growth measures alongside multi-faceted risk monitoring was advocated for the effective development of future overuse pathology prevention protocols.

The role of Gdf5 regulatory regions in development of hip morphology.

Given GDF5 involvement in hip development, and osteoarthritis (OA) and developmental hip dysplasia (DDH) risk, here we sought to assess the role(s) of GDF5 and its regulatory sequence on the development of hip morphology linked to injury risk. The brachypodism (bp) mouse, which harbors a Gdf5 inactivating mutation, was used to survey how Gdf5 loss of function impacts the development of hip morphology. Two transgenic Gdf5 reporter BAC lines were used to assess the spatiotemporal expression of Gdf5 regulatory sequences. Each BAC line was also used to assess the functional roles of upstream and downstream sequence on hip morphology. bp/bp mice had shorter femora with smaller femoral heads and necks as well as larger alpha angles, smaller anterior offsets, and smaller acetabula, compared to bp/+ mice (p<0.04). Regulatory sequences downstream of Gdf5 drove strong prenatal (E17) expression and low postnatal (6 months) expression across regions of femoral head and acetabulum. Conversely, upstream regulatory sequences drove very low expression at E17 and no detectable expression at 6 months. Importantly, downstream, but not upstream Gdf5 regulatory sequences fully restored all the key morphologic features disrupted in bp/bp mice. Hip morphology is profoundly affected by Gdf5 absence, and downstream regulatory sequences mediate its effects by controlling Gdf5 expression during development. This downstream region contains numerous enhancers harboring risk variants related to hip OA, DDH, and dislocation. We posit that subtle alterations to morphology driven by changes in downstream regulatory sequence underlie this locus' role in hip injury risk.

Hip Vascularity: A Review of the Anatomy and Clinical Implications.

Throughout development, the vascular supply to the proximal femur and acetabulum undergoes a series of changes during which it is susceptible to injury. Before age 3 months, the ligamentum teres and lateral epiphyseal arteries are the dominant supply to the developing head. The dominant supply shifts to the lateral epiphyseal vessels by age 18 months. The distinct metaphyseal and epiphyseal circulations of the adult proximal femur form in adolescence when an increasingly rich metaphyseal circulation supplies the subphyseal region, terminating at the physeal plate. The acetabular blood supply derives from two independent systems, with the dominance of each changing throughout maturity. Most descriptions of the vascular contributions to the proximal femur and acetabulum have been gross anatomic and histologic studies. Advanced imaging studies (eg, CT angiography, perfusion MRI) have added to our understanding of the vascular anatomy of the proximal femur and acetabulum, its changes throughout development, and its clinical implications.

A Genome-Wide Association Study Uncovers a Genetic Locus Associated with Thoracic-to-Hip Ratio in Koreans.

The thoracic-to-hip circumference ratio (THR) is an anthropometric marker recently described as a predictor of type 2 diabetes. In this study, we performed a genome-wide association study (GWAS) followed by confirmatory analyses to identify genetic markers associated with THR. A total of 7,240 Korean subjects (4,988 for the discovery stage and 2,252 for the confirmatory analyses) were recruited for this study, and genome-wide single nucleotide polymorphism (SNP) genotyping of the initial 4,988 individuals was performed using Affymetrix Human SNP array 5.0. Linear regression analysis was then performed to adjust for the effects of age, sex, and current diabetes medication status on the THR of the study subjects. In the initial discovery stage, there was a statistically nominal association between minor alleles of SNP markers on chromosomes 4, 8, 10, and 12, and THR changes (p < 5.0 × 10-6). The subsequent confirmatory analyses of these markers, however, only detected a significant association between two SNPs in the HECTD4 gene and decreased THRs. Notably, this association was detected in male (rs11066280: p = 1.14 × 10-2; rs2074356: p = 1.10 × 10-2), but not in female subjects. Meanwhile, the combined results from the two analyses (initial and confirmatory) indicated that minor alleles of these two intronic variants exhibited a significant genome-wide association with decreased THR in the male subjects (n = 3,155; rs11066280: effect size = -0.008624, p = 6.19 × 10-9; rs2074356: effect size = -0.008762, p = 1.89 × 10-8). Furthermore, minor alleles of these two SNPs exhibited protective effects on patients' risks for developing type 2 diabetes. In conclusion, we have identified two genetic variations in HECTD4 that are associated with THR, particularly in men.

The radiological assessment of pelvic obliquity in cerebral palsy and the impact on hip development.

Pelvic obliquity is a common finding in adolescents with cerebral palsy, however, there is little agreement on its measurement or relationship with hip development at different gross motor function classification system (GMFCS) levels. The purpose of this investigation was to study these issues in a large, population-based cohort of adolescents with cerebral palsy at transition into adult services. The cohort were a subset of a three year birth cohort (n = 98, 65M: 33F, with a mean age of 18.8 years (14.8 to 23.63) at their last radiological review) with the common features of a migration percentage greater than 30% and a history of adductor release surgery. Different radiological methods of measuring pelvic obliquity were investigated in 40 patients and the angle between the acetabular tear drops (ITDL) and the horizontal reference frame of the radiograph was found to be reliable, with good face validity. This was selected for further study in all 98 patients. The median pelvic obliquity was 4° (interquartile range 2° to 8°). There was a strong correlation between hip morphology and the presence of pelvic obliquity (effect of ITDL on Sharpe's angle in the higher hip; rho 7.20 (5% confidence interval 5.59 to 8.81, p < 0.001). This was particularly true in non-ambulant adolescents (GMFCS IV and V) with severe pelvic obliquity, but was also easily detectable and clinically relevant in ambulant adolescents with mild pelvic obliquity. The identification of pelvic obliquity and its management deserves closer scrutiny in children and adolescents with cerebral palsy.

Avaliação clínica e radiológica em médio prazo dos pacientes portadores de displasia do desenvolvimento do quadril submetidos a redução aberta, capsuloplastia e osteotomia de Salter / Clinical and radiographic medium-term evaluation on patients with developmental dysplasia of the hip, who were submitted to open reduction, capsuloplasty and Salter osteotomy

Objetivo: avaliar o resultado clínico e radiológico do tratamento cirúrgico da displasia do desenvolvimento do quadril em médio prazo, por meio da redução aberta, da capsuloplastia e da osteotomia de Salter et al. Métodos: foram avaliados 13 pacientes, 13 quadris, entre 2004 e 2011, tratados cirurgicamente pela técnica proposta. Uma avaliação clínica e radiológica foi feita pelos critérios de Dutoit et al. e Severin et al., respectivamente. Resultados: nos 13 quadris acometidos o índice acetabular pré-operatório variou de 27° a 50° (média de 36) e, após correção cirúrgica, para 18,5° em média, com variação de 10° a 28°, de modo que as avaliações dos índices acetabulares pré e pós-operatórios apresentaram redução com significância estatística (p < 0,05). Quanto à avaliação clínica pós-operatória, foram encontrados: nove quadris ótimos (69,2%), três bons (23,1%), nenhum regular (0%) e um ruim (7,7%). Na avaliação radiológica, foram encontrados seis quadris ótimos (46,1%), três bons (23,1%), nenhum regular (0%) e quatro ruins (30,8%). Portanto, obtiveram-se resultados favoráveis em 92,3%, pois agrupam-se quadris com avaliação ótima e boa como satisfatórios e os com avaliação regular e ruim como insatisfatórios. Atente-se que não houve significância entre a ocorrência de complicações, a idade do paciente, o momento da cirurgia e o índice acetabular pré-operatório (p > 0,05). Como complicações ocorridas, têm se três subluxações isoladas e uma subluxação associada à necrose avascular da cabeça femoral. Conclusão: a redução aberta, ...

Objective: to evaluate the clinical and radiographic medium-term results from surgical treatment of developmental dysplasia through open reduction, Salter et al.'s osteotomy and capsuloplasty. Methods: 13 patients were evaluated, 13 hips treated surgically by the proposed technique between 2004 and 2011. A clinical and radiographic evaluation was conducted by Dutoit et al. and Severin et al. criteria, respectively. Results: the acetabular preoperative index for the 13 surgically treated hips ranged from 27° to 50° (average of 36), and after surgical correction to 18.5° (10-28°), so that the evaluations of preoperative and postoperative acetabular indexes showed up significant statistic reduction (p < 0.05). Regarding the postoperative clinical evaluation, it was found: nine excellent hips Developmental (69.2%), three good ones (23.1%), no fair hips (0%) and a poor one (7.7%). In radiographic evaluation, it was found: six excellent hips (46.1%), three good ones (23.1%), no fair hips (0%) and four poor ones (30.8%). Therefore, favorable results were obtained (92.3%), with grouped hips with excellent and good ratings as satisfactory and with fair and bad ratings as unsatisfactory. It is also important to notice that there was no significance among occurrence of complications, the patient's age, the time of surgery and the preoperative acetabular index (p > 0.05). As complications occurred, it was found that three subluxations and a subluxation associated with avascular necrosis of the femoral head. Conclusion: open reduction, Salter et al.'s osteotomy and capsuloplasty are seen to be a viable option for the treatment of developmental dysplasia of the hip, according to clinical and radiological medium-term evaluations. .

Calcium and dairy products consumption and association with total hip bone mineral density in women from kosovo.

BACKGROUND AND OBJECTIVE: There is paucity of evidence in southeastern Europe and Kosovo regarding dairy products consumption and association with bone mineral density (BMD). Therefore, the objective of present study was to assess calcium intake and dairy products consumption and to investigate relationship with total hip BMD in a Kosovo women sample. METHODS: This cross-sectional study included a sample of 185 women divided into respective groups according to total hip BMD. All the study participants completed a food frequency questionnaire and underwent dual-energy X-ray absorptiometry (DEXA) to estimate BMD. Nonparametric tests were performed to compare characteristics of the groups. RESULTS: The average dietary calcium intake was 818.41 mg/day. Only 16.75% of the subjects met calcium recommended dietary reference intakes (DRIs). There were no significant differences between low BMD group and normal BMD group regarding average dietary calcium intake, but it was significantly higher in BMDT3 subgroup than in BMDT2 and BMDT1 subgroups. CONCLUSIONS: The results of this study demonstrate significant relationship of daily dietary calcium intake with upper BMD tertile. Further initiatives are warranted from this study to highlight the importance of nutrition education.

Foetal and postnatal equine articular cartilage development: magnetic resonance imaging and polarised light microscopy.

Adult articular cartilage (AC) has a well described multizonal collagen structure. Knowledge of foetal AC organisation and development may provide a prototype for cartilage repair strategies, and improve understanding of structural changes in developmental diseases such as osteochondrosis (OC). The objective of this study was to describe normal development of the spatial architecture of the collagen network of equine AC using 1.5 T magnetic resonance imaging (MRI) and polarised light microscopy (PLM), at sites employed for cartilage repair studies or susceptible to OC. T2-weighted fast-spin echo (FSE) sequences and PLM assessment were performed on distal femoral epiphyses of equine foetuses, foals and adults. Both MRI and PLM revealed an early progressive collagen network zonal organisation of the femoral epiphyses, beginning at 4 months of gestation. PLM revealed that the collagen network of equine foetal AC prior to birth was already organised into an evident anisotropic layered structure that included the appearance of a dense tangential zone in the superficial AC in the youngest specimens, with the progressive development of an underlying transitional zone. A third, increasingly birefringent, radial layer developed in the AC from 6 months of gestation. Four laminae were observed on the MR images in the last third of gestation. These included not only the AC but also the superficial growth plate of the epiphysis. These findings provide novel data on normal equine foetal cartilage collagen development, and may serve as a template for cartilage repair studies in this species or a model for developmental studies of OC.

Fetal and infant growth predict hip geometry at 6 y old: findings from the Southampton Women's Survey.

BACKGROUND: We investigated relationships between early growth and proximal femoral geometry at age 6 y in a prospective population-based cohort, the Southampton Women's Survey. METHODS: In 493 mother-offspring pairs, we assessed linear size using high-resolution ultrasound at 11, 19, and 34 wk gestation (femur length) and at birth and 1, 2, 3, 4, and 6 y (crown-heel length/height). SD scores were created and conditional regression modeling generated mutually independent growth variables. Children underwent hip dual-energy X-ray absorptiometry (DXA) at 6 y; hip structure analysis software yielded measures of geometry and strength. RESULTS: There were strong associations between early linear growth and femoral neck section modulus (Z) at 6 y, with the strongest relationships observed for femur growth from 19 to 34 wk gestation (ß = 0.26 cm(3)/SD, P < 0.0001), and for height growth from birth to 1 y (ß = 0.25 cm(3)/SD, P < 0.0001) and 1 to 2 y (ß = 0.33 cm(3)/SD, P < 0.0001), with progressively weaker relationships over years 3 (ß = 0.23 cm(3)/SD, P = 0.0002) and 4 (ß = 0.10 cm(3)/SD, P = 0.18). CONCLUSION: These results demonstrate that growth before age 3 y predicts proximal femoral geometry at 6 y old. These data suggest critical periods in which there is capacity for long-term influence on the later skeletal growth trajectory.

[Retrospective analysis on total hip arthroplasty for the treatment of developmental dysplasia of the hip in 29 adults].

OBJECTIVE: To study the results of the total hip arthroplasty (THA) in the treatment of developmental dysplasia of the hip (DDH) with severe osteoarthritis in adults. METHODS: From March 2004 to February 2011, 29 patients (32 hips) with DDH were treated by THA with an cementless cup. There were 11 males and 18 females,with an average age of 52.6 years (ranging from 37 to 73 years). Unilateral DDH occurred in 26 patients and bilateral DDH occurred in 3 patients. Based on the Crowe classification, there were 18 hips in 17 patients of type I ,7 hips in 6 patients of type II, 4 hips in 3 patients of type III, 3 hips in 3 patients of type IV. Except for 3 patients with bilateral DDH, the other patients' ill lower limbs were 1 to 6 cm shorter than the healthy lower ones. RESULTS: All the patients were followed up,and the duration ranged from 8 months to 5.3 years(averaged 3.7 years) without infection, dislocation, and sciatic nerves injury after the operation. One patient with proximal femoral fracture, intraoperation used wire binding, after 4 years of follow-up, fracture healed without evidence of prosthesis loosening. All grafts and subtrochanteric osteotomy healing were achieved. In 21 patients, the pain was completely relieved and the function of the hip joints was good. Five patients still had mild limping, but reduced significantly than preoperation. In 3 patients, the ill lower limbs were more than 1 cm shorter than the healthy lower ones and the other patients' ill lower limbs were less than 1 cm shorter than the healthy lower ones. Two patients' lower limbs were lengthened 4 to 5 cm. The Harris scores were 43.6 +/- 7.1 preoperatively and 86.7 +/- 5.3 postoperatively (P < 0.05). CONCLUSION: THA with deepening the medial wall of the acetabulum at the true acetabulum, according to different characteristics of Crowe classification, using different operation program, cementless cup in adult could obtain favorable results.

Associations of hip circumference and height with incidence of type 2 diabetes: the Isfahan diabetes prevention study.

The aim of this study was to determine the effects of hip circumference (HC) and height on diabetes incidence in non-diabetic first-degree relatives (FDRs) of patients with type 2 diabetes. A total of 1,092 (254 men and 838 women) non-diabetics FDRs ≥ 30 years old in 2003-2005 were followed through 2010 for the occurrence of type 2 diabetes. At baseline and through follow-ups, participants were underwent a standard 75 g 2-h oral glucose tolerance test. The incidence of type 2 diabetes was 17.0 (95% CI: 13.7, 20.2) (13.0 men and 18.1 women) per 1,000 person-year based on 6,015 person-years of follow-up. Height was inversely associated with diabetes incidence. The age-, gender-, and waist-adjusted relative risk (95% CI) of diabetes was 0.54 (0.31, 0.93) for highest quartile of height and 0.59 (0.25, 1.37) for highest quartile of HC compared with lowest quartile. These data indicate that height was inversely associated with diabetes incidence, independently of gender among FDRs of patients with type 2 diabetes.

[Evolution of the pelvis and hip throughout history: from primates to modern man]. / Évolution du bassin et de la hanche « à travers les âges ¼: des primates à l'homme moderne.

The evolution to a bipedal mode of locomotion was accompanied by a verticalization of the spine and a modification in the shape of the pelvis: horizontal curvature and sagittal rotation. Phylogenesis meets ontogenesis: flat bones in fetuses similar to the monkey, australopithecus features at birth and "human-like" features by 7 or 8years of age. These anatomical modifications explain the characteristics of human bipedalism: stable, economical, with hip and knee extension in the standing position with little lateral motion. Some pathologies induce a regression to a more archaic mode of bipedal locomotion.

Comparisons of housing, bedding, and cooling options for dairy calves.

Housing, bedding, and summer cooling were management options evaluated. Holstein calves (42±2 kg of body weight) initially 2 to 5 d of age were managed in southwest Ohio in poly hutches or wire mesh pens in a curtain-sided nursery with no supplemental heat. Calves were fed milk replacer (27% crude protein, 17% fat fed at 0.657 kg of dry matter per calf daily), starter (20% crude protein dry matter, textured, fed free-choice), and water (free-choice). Measurements were for 56 d. In trial 1, 28 calves per treatment were bedded with straw and housed in either hutches or nursery pens. This trial was conducted from September to March; the average temperature was 8°C and ranged from -17 to 31°C. In trial 2a, 16 calves per treatment were managed in nursery pens bedded with straw, in nursery pens bedded with sand, or in hutches bedded with sand. This trial was conducted from May to September; the average temperature was 21°C and ranged from 7 to 33°C. In trial 2b, 26 calves per treatment were housed in nursery pens and bedded with straw. This trial was conducted from May to September; the average temperature was 22°C and ranged from 8 to 34°C. One treatment was cooled with fans between 0800 and 1700 h and the other was not. Data were analyzed as repeated measures in a completely randomized block design by trial, with calf as the experimental unit. In trial 3, air in the nursery and calf hutches used above was sampled 35 d apart for calves aged 5 and 40 d. Air in individual hutches on 2 commercial farms was sampled for 5- and 40-d-old calves for 2 hutch types. Air in the multi-calf hutches was sampled for calves of 75 and 110 d of age. Bacterial concentrations of air samples were analyzed (log10) as odds ratios by Proc Logistic in SAS software (SAS Institute Inc., Cary, NC); differences were declared at P<0.05. In trial 1, weight gain of calves in nursery pens was 6% greater and feed efficiency was 4% greater than that of calves in hutches. In trial 2a, weight gain and starter intake of calves in the nursery with straw bedding were greater and scouring was less than that in calves bedded with sand in the nursery or hutches. The relative humidity was greater in the hutches than in the nursery pens. In trial 2b, weight gain, feed efficiency, and hip width change were greater and breaths per minute were less for calves cooled with fans compared with calves that were not cooled. In trial 3, airborne bacteria concentrations were greater in the hutches than in the nursery pens. Straw bedding (vs. sand), nursery pens (vs. hutches), and summer daytime cooling with fans improved calf weight gain.

Avaliação clínica e radiológica após procedimento de Salter e Ombrédanne na displasia de desenvolvimento do quadril / Clinical and radiological evaluation on developmental hip dysplasia after salter and Ombrédanne procedure

OBJETIVO: Avaliar o resultado clínico e radiológico em médio prazo do tratamento cirúrgico da displasia do desenvolvimento do quadril através da osteotomia do osso inominado de Salter e o encurtamento femoral de Ombrédanne. MÉTODOS: Foram avaliados 14 pacientes, 18 quadris (sete quadris do lado direito e 11 do lado esquerdo), todos tratados cirurgicamente entre 1998 e 2008 pela técnica proposta. Foi realizada avaliação clínica e radiológica pelos critérios de Dutoit e Severin, respectivamente. RESULTADOS: Nos sete quadris do lado direito o índice pré-operatório médio foi de 43,3º (40º a 50º), sendo corrigido cirurgicamente, em média, para 31,57º (24º a 42º), enquanto os 11 quadris do lado esquerdo tinham média pré-operatória de 42,1º (36º a 56º) evoluindo para 30,36º (20º a 44º), sendo que as avaliações dos índices acetabulares pré e pós-operatórios apresentaram significância estatística com P < 0,05. Na avaliação clínica foram encontrados sete quadris ótimos (38,9 por cento), oito bons (44,4 por cento), três regulares (16,7 por cento) e nenhum ruim (0 por cento). Agrupando quadris com avaliação boa e ótima como satisfatórios e os com avaliação ruim e regular como insatisfatórios, obtiveram-se resultados favoráveis em 83,3 por cento dos casos. Não se obteve significância estatística entre a ocorrência de complicações e a idade do paciente, no momento da cirurgia, e o índice acetabular pré-operatório (p > 0,05). Como complicações, ocorreram uma subluxação, uma osteonecrose e uma osteonecrose associada à subluxação. CONCLUSÃO: O procedimento combinado de Salter e Ombrédanne é uma opção viável para o tratamento da displasia de desenvolvimento do quadril após o início da marcha.

OBJECTIVE: To evaluate the clinical and radiological medium-term results from surgical treatment of developmental hip dysplasia through Salter innominate bone osteotomy and Ombrédanne femoral shortening. METHODS: Fourteen patients were evaluated, with surgical treatment on 18 hips (seven right-side hips and eleven left-side hips) using the proposal technique, performed between 1998 and 2008. The Dutoit and Severin criteria were used respectively for clinical and radiographic evaluations. RESULTS: The average preoperative index for the seven right-side hips was 43.3º (40º to 50º), and this was corrected through surgery to an average of 31.57º (24º to 42º). The average preoperative index for the eleven left-side hips was 42.1º (36º to 56º), and this was corrected through surgery to an average of 30.36º (20º to 44º). There was a statistically significant difference between the preoperative and postoperative acetabular indexes, with P < 0.05. The clinical evaluation showed that there were seven excellent hips (38.9 percent), eight good ones (44.4 percent), three fair hips (16.7 percent) and no poor ones (0 percent). By grouping the hips rated good and excellent as satisfactory and those rated poor and fair as unsatisfactory, 83.3 percent of the results were seen to be favorable. There were no statistically significant correlations between occurrences of complications and patient age at the time of surgery or between complications and the preoperative acetabular index (p > 0.05). The complications observed consisted of one case each of subluxation, osteonecrosis and osteonecrosis together with subluxation. CONCLUSION: The combined procedure of Salter and Ombrédanne is a viable option for treating developmental hip dysplasia after patients have started to walk.

Displasia do desenvolvimento do quadril: atualização / Dysplasia of hip development: update

A terminologia "Displasia do Desenvolvimento do Quadril - DDQ" descreve o amplo espectro de alterações que atingem o quadril em crescimento, desde a displasia até a luxação da articulação, passando pelos diferentes graus de subluxação da coxofemoral. A incidência da DDQ é variável, dependendo de vários fatores, inclusive da localização geográfica. Aproximadamente um em cada 1.000 recém-nascidos poderá nascer com o quadril luxado e cerca de 10 em 1.000 com o quadril subluxado (instável). Em nosso meio podemos esperar a incidência de cinco por 1.000 quanto à positividade do sinal de Ortolani, que é o sinal clínico precoce de detecção da afecção. Os fatores de risco para a DDQ incluem: sexo feminino, raça branca, primiparidade, mãe jovem, apresentação pélvica ao nascimento, história familiar, oligohidrâmnio, recém-nascido com maiores peso e altura e com deformidades nos pés ou na coluna vertebral. O exame do quadril do recém-nascido deverá ser rotineiro e enfatizado nos berçários. No recém-nascido e nos bebês o diagnóstico da DDQ é eminentemente clínico e realizado com as manobras de Ortolani e de Barlow. A radiografia convencional tem um valor limitado na confirmação diagnóstica da DDQ nos recém-nascidos sendo a ultrassonografia do quadril o exame ideal. O tratamento da DDQ é desafiador tanto para o ortopedista pediátrico como para o generalista. Os objetivos do tratamento incluem o diagnóstico o mais precocemente possível, a redução da articulação e a estabilização do quadril em uma posição segura. Classicamente dividimos as possibilidades do tratamento de acordo com as diferentes faixas etárias, por ocasião do diagnóstico.

The term "Developmental Dysplasia of the Hip - DDH" includes a wide spectrum of abnormalities in the immature hip, ranging range from subtle dysplasia to joint dislocation. The incidence of DDH is variable, and depends on a number of factors, such as geographical location. Approximately one in 1,000 newborn infants may present hip dislocation and 10 in 1,000 present hip instability. Brazil has an incidence of five per 1,000 in terms of the positive Ortolani signal, which is the early clinical signal for detecting the disorder. The risk factors for DDH include: female sex, Caucasian race, first labor, young mother, breech presentation on birth, family history, oligohydramnios , newborn with higher weight and height, and deformities of the feet or spine. Hip examination of the newborn should be routine, and should be emphasized in maternity units. In newborn infants and babies, the diagnosis of DDH is preeminently clinical and is carried out using the Ortolani and Barlow maneuvers. Conventional X-ray is of limited value for confirming the diagnosis of DDH in the newborn infant, and ultrasound of the hip is the ideal exam. The treatment of DDH is challenging, both for the pediatric orthopedist and for the general practitioner. The objectives of the treatment include early diagnosis, reduction of the articulation, and stabilization of the hip in a secure position. Classically, treatment options are divided according to the different age groups, at the time of diagnosis.

Displasia do desenvolvimento do quadril / Developmental dysplasia of the hip

Os autores se propõem neste artigo a realizar uma revisão acerca do tema displasia do desenvolvimento do quadril abordando: fisiopatologia , manifestações clinicas,diagnóstico e tratamento.