1/6. Outcome of ultrasonographic hip abnormalities in clinically stable hips.A retrospective review was performed of 192 newborn hips in 112 patients referred for hip evaluation. The average age at presentation was 12.7 days, with average radiographic follow-up of 15.9 months. Inclusion criteria for our study were a normal physical examination of the hip without evidence of instability and an ultrasound examination that was considered abnormal. Pavlik harness treatment was chosen at the discretion of the treating physician. At final follow-up, dysplasia was defined as greater than two standard deviations above the mean acetabular index (AI) for age. Group I consisted of 43 hips that had Pavlik treatment, and group II consisted of 149 hips that did not receive treatment. There was no difference in these two groups with respect to risk factors for dysplasia or the initial abnormalities seen on ultrasound evaluation, although patients in group I had less coverage of the femoral head during stress maneuvers. No hip in group I and two (1.3%) hips in group II were considered dysplastic (AI > 2 SD) at final radiographic follow-up (p > 0.10). There was no correlation between the severity of the ultrasound abnormality at birth and the subsequent presence of dysplasia (p > 0.10). The two hips considered dysplastic on radiograph were not being actively treated. When the hip examination of a newborn hip younger than 1 month is normal, a screening ultrasound does not appear to predict accurately subsequent hip dysplasia. In this specific setting, an initial screening ultrasound may be too sensitive and does not appear warranted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Abduction treatment in late diagnosed congenital dislocation of the hip. Follow-up of 1,010 hips treated with the Frejka pillow 1967-76.There are many countries such as poland where treatment of congenital hip dislocation is started late. The purpose of this work was to report our results in this group of children. 1010 hips in 780 children with congenital dislocation of the hip were treated with the Frejka pillow. The early results were evaluated in 830 hips at 15-36 months of age and the late results in 527 hips at a mean age of 14 (10-21) years. 90 percent of the children were treated by the same physician. The age at the onset of the treatment varied from 2 weeks to 24 months, with 12 percent younger than 3 months and 28 percent older than 6 months. The initial degree of dislocation was determined with our own index. Radiographic results were evaluated with a scoring based on four or six parameters. There were 6 percent failures, including lack of reduction or redislocation at the time when the child started to walk. Ischemic necrosis was observed in 14 percent of the hips, with significant permanent sequelae in 5 percent. Indications for surgical treatment of residual dysplasia were found in 4 percent of the hips evaluated early; and in the group evaluated late, still 5 percent of the hips required operation. There was good ability for spontaneous remodeling between the age of 3 and 7 years, whereas around the age of 10, the radiographic appearance of the hip became stabilized. At the end of treatment and at the time when the children started to walk, 59 percent of the early evaluated hips were still insufficiently remodeled; but in cases evaluated late, 95 percent of them had a normal or almost normal radiographic appearance. At that time, the clinical state of the children was satisfactory. The results of treatment depended on the initial degree of displacement. Only when treatment was begun after 5 months of age did the patient's age affect the treatment results. The Frejka pillow successfully reduced and stabilized these hips.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. Management of congenital hip dysplasia.In summary, congenital hip dysplasia remains a worldwide health problem, which has not been resolved by neonatal screening programs. The primary care physician's role is critical for early diagnosis. An understanding of the need for repeated examinations, the age related signs, and continued diligence is essential. The common use of the triple diaper treatment is not recommended.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Hip instability encountered in pediatric podiatry practice.Infants and children with pathologic conditions of the foot and leg frequently have predictable comorbidity. The treating physician has the responsibility for identifying these associated problems and promptly referring if the problem is outside of his or her area of expertise. Hip dysplasia and dislocation occur frequently enough in association with congenital foot and leg deformity that they must be actively sought out in all cases. This article presents an overview of the topic, a review of screening protocols and appropriate imaging techniques and case studies of children with hip instability encountered in pediatric podiatry practice.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. deafness and Mondini dysplasia in Kabuki (Niikawa-Kuroki) syndrome. Report of a case and review of the literature.Report of a case and review of the literature: We report the case of a seven-year-old female kabuki patient suffering from severe bilateral deafness related to Mondini dysplasia and ossicular anomalies. A review of the literature in English confirms that hearing loss is a major component of Kabuki syndrome (KS) with a frequency at around 32%. However the possible mechanisms have not been fully described and hearing loss is often attributed to otitis media, but one reported case had severe ossicular malformations, two had sensorineural deafness and three others had mixed deafness. Our observation is the first reported case of Mondini dysplasia in KS. awareness by physicians of this problem has a major practical consequence as diagnosis of Mondini dysplasia implies searching for and surgical prevention and treatment of perilymphatic fistula in order to prevent meningitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Bilateral hip dysplasia. A case report.BACKGROUND: Hip dysplasia affects 1% of newborns. Our health system screening begins at birth, and our educational system requires health screens at various ages, so physicians in this country rarely find an adult with an undiagnosed congenital condition. CASE: Bilateral hip dislocation was diagnosed on a 20-year-old, nulliparous woman who had just arrived from puerto rico. She tolerated her abnormal gait well, unaware of the condition of her hips. After an unremarkable prenatal course, she was admitted at term with ruptured membranes for stimulation of labor. She developed secondary arrest of labor, and a healthy, 3,180-g, female infant was delivered by cesarean. CONCLUSION: In hip dysplasia, early diagnosis (and therapy) prevents long-term consequences.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |