Evaluation of Brace Treatment for Infant Hip Dislocation in a Prospective Cohort: Defining the Success Rate and Variables Associated with Failure.

Background: The use of a brace has been shown to be an effective treatment for hip dislocation in infants; however, previous studies of such treatment have been single-center or retrospective. The purpose of the current study was to evaluate the success rate for brace use in the treatment of infant hip dislocation in an international, multicenter, prospective cohort, and to identify the variables associated with brace failure.

Methods: All dislocations were verified with use of ultrasound or radiography prior to the initiation of treatment, and patients were followed prospectively for a minimum of 18 months.

A Practical Approach to Determining the Center of the Femoral Head in Subluxated and Dislocated Hips.

Background: Mistaking the ossific nucleus as the surrogate for the center of the femoral head affects treatment decisions in hip dysplasia. Previous studies of ossific nucleus position within the femoral head have been qualitative, or, have not included both subluxated and dislocated hips. The purpose of this study was, first, to determine the most accurate radiographic landmark to define the center of the immature femoral head in hip dysplasia, and, second, to quantitatively analyze the position of the ossific nucleus relative to the center of the femoral head.

Evidence-based medicine: not a slam dunk.

Evidence-based medicine is not easy. Some difficulties are obvious, such as the difficulty to mount a powerful random prospective controlled study. This article, however, will deal with 2 types of not-so-obvious, difficulties that plague clinicians who advocate evidence-based medicine.

Risk factors for failure after open reduction for DDH: a matched cohort analysis.

Background: No controlled data exists regarding the risk factors for redislocation after a technically proficient open reduction for developmental dysplasia of the hip (DDH). The purposes of this study were to examine predictors of redislocation and to evaluate the long-term outcomes after revision surgery.

Methods: We performed a retrospective match-controlled study comparing 22 patients who had successful open reduction for DDH with 22 who required revision open reduction.

Femoral head sphericity in untreated developmental dislocation of the hip.

Background: Although many studies have discussed acetabular changes in walking aged children with developmental dysplasia of the hip (DDH), almost no data exists in the literature regarding dysplasia of the femoral head. The purpose of our study was to quantify the sphericity of the femoral head in a large, consecutive series of walking aged children with DDH.

Methods: We conducted a prospective study on 37 consecutive hips (30 patients) that were undergoing surgical procedures for DDH.

Unilateral proximal bifurcation of the femur.

We present a case report of a boy with a unilateral bifurcation of the proximal femur with a bifid femoral neck and 2 femoral heads. The patient had no other musculoskeletal or neurovascular abnormalities. One femoral head articulated with the acetabulum but the nonarticulating, larger head was better developed.

Femoral anteversion in developmental dysplasia of the hip.

Background: Limited data exist in the literature with regard to the amount of femoral anteversion in children with developmental dysplasia of the hip (DDH). The data that do exist are variable: certain studies cite increased version in DDH compared with normal while others have found no significant difference. The purpose of our study was to quantify the degree of femoral anteversion in a large, consecutive series of children with DDH.

Predictors of the need for femoral shortening osteotomy during open treatment of developmental dislocation of the hip.

Background: It is well accepted that femoral shortening osteotomy can reduce the risk of complications after open reduction of developmental dislocation of the hip (DDH), especially in older children and "high" dislocations. It remains unclear, however, at what age a child needs a femoral shortening osteotomy and what exactly constitutes a "high" dislocation. The purpose of our study was to evaluate age and femoral displacement as predictors of the need for a femoral shortening osteotomy during the open treatment of DDH.

Growth rates in skeletally immature feet after triple arthrodesis.

Many authors delay triple arthrodesis in skeletally immature patients secondary to the belief that such a surgery would cause excessive shortening in a foot that is often already short. In the current study, foot growth rates were compared between a group of skeletally immature patients (<11 years) and a group of more skeletally mature patients (>11 years) after triple arthrodesis. The average age at surgery in the skeletally immature group was 9.

Recurrence of varus deformity after proximal tibial osteotomy in Blount disease: long-term follow-up.

In a retrospective review of 74 tibial osteotomies performed for Blount disease, the patients were divided into three groups based on age and treatment. Group A (26 osteotomies), 4 years old or younger, and group B (34 osteotomies), older than 4 years, were treated the same with osteotomy and crossed pins. Group C (14 osteotomies), older than 4 years, was treated with osteotomy and external fixator.

Relative tibial and femoral varus as a predictor of progression of varus deformities of the lower limbs in young children.

Many young children present to pediatric orthopaedic surgeons with genu varum and mild beaking of the medial metaphysis on x-ray. Predicting whether these deformities will progress is challenging. In addition, there is no consensus as to whether these children should all be classified as having Blount disease.