[Open reduction with pelvic osteotomy and femoral shortening].

The combined procedure of femoral shortening, reduction of the hip, iliac osteotomy, transfer of the iliopsoas muscle, and redirection of the femoral head, applied in 225 hips of children over the age of 7, gave good results in two-thirds of the cases, and poor in one-tenth. The quality of the outcome diminished with increasing age at surgery.

[Prevention, care and screening of hips of newborn infants].

The frequency of C.D.H.

Long-term results of combined operative reduction of the hip in older children.

Long-term results of open reduction, combined with femoral shortening, iliac osteotomy, reorientation of the upper femur, and medial iliopsoas transfer, are analyzed in 144 hips, according to patients' answers to follow-up questionnaires. Age at surgery ranged from 7 to 15 years with a follow-up of 9-24 years (mean 13 years). Two-thirds of patients had good results, one-fourth had fair results, and one-tenth had poor results.

Effects of triple prevention of CDH, stimulated by distribution of "baby packages".

Triple prevention of congenital dislocation of the hip (CDH) consists of screening and earliest treatment in newborns, universal wide diapering in all presumably healthy hips, and repeated screening and early treatment in infants. Preventive activity proved to be decisively stimulated by introduction of "baby packages," containing equipment for wide diapering, which are being distributed to every newborn free of charge. Since the introduction of baby packages, prevalence of CDH dropped from 1.

Chiari's pelvic osteotomy in the treatment of Legg-Calvé-Perthes disease.

Results of Chiari's pelvic osteotomy in Legg-Calvé-Perthes disease were analyzed in 37 hips of 36 patients. The mean age at surgery was nine years. The results were assessed according to both the quality of sphericity and containment of the femoral head.

Triple prevention of congenital dislocation of the hip.

Triple prevention of congenital dislocation of the hip consists of (a) examining newborns so as to apply treatment as early as possible in symptomatic and suspected cases, (b) regular diapering in abduction of all presumably healthy hips by means of soft abduction pants so as to direct possible cases of dysplasia toward normal development, and (c) reexamination of these hips until the child can walk so as to discover missed cases. Primary treatment of diagnosed and suspected hip dislocations consists of immediate application of a Frejka splint and abduction exercises, followed by a radiograph at the age of 4 months. Persistence of any clinical symptom for 3 weeks requires intensification of treatment by use of the Pavlik harness.

Perthes' disease.

Perthes' disease may be regarded as a generalised disorder of cartilage development in which there is a particular predisposition for repeated episodes of infarction in the proximal femoral epiphysis. The resulting deformation of the head is due to collapse of the ossific nucleus and irregular growth of the cartilage. The shape of the epiphysis is determined by the pressure of the surrounding structures.

Treatment of Perthes' disease in older children.

The results of treating 148 hips in 135 children (aged 7 to 16 at the onset of management) for Perthes' disease are analysed. Cases are classified according to the amount of epiphysial containment and the results assessed according to the degree of preserved sphericity. It is concluded that to obtain satisfactory results in this age group treatment should be prolonged until the restitution of the epiphysis so as to maintain the initially achieved containment throughout the reparative process.

Cylindrically modeled bone grafts.

A technique of autogenous grafting for repair of large defects in long bones is presented. Quadrangular grafts, taken from the external table of the posterior ilium, are modeled by bending them into cylindrical form, which has higher mechanical resistance as compared to flat struts. Cancellous chips are added.

Relocation of congenitally elevated scapula.

In the treatment of Sprengel's deformity, extraperiosteal greenstick fracture of the clavicle in conjunction with surgical release of all attachments between the scapula and the spine provides an easy, safe method of relocating the scapula to its normal level. The improved position is maintained by temporary fixation of the inferior border of the scapula to the eighth rib with slowly resorbable sutures. Section of the coracoclavicular ligaments, excision of the superior pole of the scapula, and suture fixation of the medial angle of the scapula to the spinous process of the fourth vertebra enables the procedure to be performed on patients until the age of puberty.

Approach to treatment of Legg-Calvé-Perthes disease.

The essence of management of Legg-Calvé-Perthes disease (LCPD) should be the provision of containment and its maintenance during epiphyseal remodeling. Containment may be achieved by a variety of nonoperative and surgical methods. The choice for individual patients depends on the patients' age at onset and the degree of epiphyseal involvement.

[Wrapping in abduction of newborns in maternity wards].

Triple prevention of the congenital dysplasia of the hip comprises detection in newborns, general wrapping in abduction, and detection in infants. It starts already in obstetric institutions and is legalized as an obligatory form of health protection of the population. Baby-packages for prophylactic wrapping with the thigh in abduction and flexion, are provided for each newborn free of change and distributed in the maternity wards.

Combined procedure of open reduction and shortening of the femur in treatment of congenital dislocation of the hips in older children.

A one-stage, combined operative procedure for reduction of congenitally dislocated hips in older children consists of shortening of the femur; open reduction by an inferior approach to the joint; reconstruction of the acetabular roof; correction of anteversion of both the femoral neck and the neck-shaft angle; anterior transposition of the iliopsoas muscle. On 60 hips operated in children, ages 5 to 15 with a follow-up period, ranging from 5 to 9 years, the results were found to be excellent in 3 per cent, good in 60 per cent, fair in 30 per cent, and poor in 7 per cent. The procedure is indicated in children up to the time of early puberty.