Functional and Radiologic Results of Posteromedial Limited Surgery in Developmental Dysplasia of the Hip.

PURPOSE OF THE STUDY In treatment algorithm of developmental dysplasia of the hip, posteromedial limited surgery is placed between closed reduction and medial open articular reduction. The aim of the present study was to assess the functional and radiologic results of this method. MATERIAL AND METHODS This retrospective study was performed in 37 Tönnis grade II and III dysplastic hips of 30 patients. The mean age of the patients at operation was 12.4 months. The mean follow-up time was 24.5 months. Posteromedial limited surgery was applied when sufficient stable concentric reduction was not achieved by closed technique. No pre-operative traction was applied. Postoperatively, human position hip spica cast was applied for 3 months. Outcomes were evaluated regarding modified McKay functional results, acetabular index and presences of residual acetabular dysplasia or avascular necrosis. RESULTS Thirty-six hips had satisfactory and one hip had poor functional result. The mean pre-operative acetabular index was 34.5 degrees. It improved to 27.7 and 23.1 degrees at the postoperative 6th month and the last control X-Rays. The change in acetabular index was statistically significant (p<0.05). At the last control, 3 hips had findings of residual acetabular dysplasia and 2 hips had avascular necrosis. CONCLUSIONS Posteromedial limited surgery for developmental dysplasia of the hip is indicated when closed reduction remains insufficient and medial open articular reduction remains unnecessarily invasive. This study, in line with the literature, provides evidences that this method might decrease the incidences of residual acetabular dysplasia and avascular necrosis of the femoral head. Key words: developmental dysplasia of the hip, posteromedial limited surgery, closed reduction, medial open reduction.

The relationship between the location of neonatal clavicular fractures and predisposing factors.

BACKGROUND: The aim was to investigate the maternal and fetal predisposing factors of clavicle fracture locations in newborns. METHODS: A retrospective evaluation was made of 77 clavicle fractures identified from a total of 33,480 live newborns between September 2016 and September 2018 at a single center in Turkey. Fractures were grouped according to the Allman classification: Group I mid third, Group II lateral distal third, Group III medial proximal third of the clavicle, respectively. Demographic features compared between the groups included maternal age, parity and height and infantile gestational age, gender, birth weight and length. Neonatal clinical features were also compared between the three groups and included mode of delivery, Apgar score, fracture laterality, time to diagnosis, mode of diagnosis, and presence of symptoms of brachial plexus palsy. RESULTS: There were no statistically significant differences between the three groups when the demographic characteristics of the mothers and newborns were compared. In terms of clinical characteristics Group 3 contained a higher proportion of patients with symptoms of brachial plexus palsy than Group 1 (61.5% versus 22%, p = 0.017). There was no statistically significant difference between Groups 2 and 3 and Groups 1 and 2. CONCLUSION: A significant association was found between the occurrence of brachial plexus palsy and fracture of the medial third of the clavicle (Allman type III).