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 = physical examination, physical (Clic here for more details about this article) |
2/6. Bernese periacetabular osteotomy for hip dysplasia in young adults.hip dysplasia is one of the most common disorders of the hip, presenting in the first three years of life. literature has shown that an association exists between developmental dysplasia of the hip and the development of secondary hip osteoarthritis in early adulthood. Treatment options are directed toward relieving symptoms and delaying or preventing the onset of arthritis in the affected hip. Total hip arthroplasty is a surgical option, but has been associated with a high rate of failure in younger, physically active patients. This article discusses the Bernese periacetabular osteotomy procedure as a treatment modality, which restores coverage of the femoral head with the acetabulum. Changing the anatomy allows the surgeon to increase the surface area of the femoral head that bears the patient's weight. Increasing the weight-bearing surface may prevent further damage to the hip's cartilage and delay the onset of osteoarthritis.- - - - - - - - - - ranking = 0.059496736690809keywords = physical (Clic here for more details about this article) |
3/6. Ultrasound screening of high-risk infants. A method to increase early detection of congenital dysplasia of the hip.Congenital dysplasia of the hip (CDH) continues to be missed by routine physical screening examinations in the early months when treatment is most effective. Real-time ultrasonography (US) is valuable in the detection of CDH in the young infant. We performed a prospective study to evaluate one US screening strategy that targets a select "high-risk newborn" population at risk for CDH aiming to increase the early diagnosis of this condition. From 1772 consecutive births at one hospital, we identified 97 (5.5%) newborns with risk factors for CDH: breech delivery, 73 babies; family history, 26 babies; postural abnormalities, five babies; and oligohydramnios, four babies. Eleven newborns had two risk factors. We studied 69 of these newborns with US. There were four cases of CDH in this group. Three of these babies had completely normal pediatric physical examination results at the time of the US study (at 14, 75, and 100 days, respectively) despite dysplasia diagnosed by US. All were successfully treated with a harness as outpatients. We conclude that a screening program entailing identification and subsequent US of the hip of newborns with specific physical and historical risk factors for CDH increases early diagnosis. Further analysis suggests this approach is cost-effective.- - - - - - - - - - ranking = 1.1189934733816keywords = physical examination, physical (Clic here for more details about this article) |
4/6. Missed or developmental dislocation of the hip.In 15 documented cases, subluxation or dislocation of the hip was discovered months or years after previous multiple normal physical examinations. The examiners were unique in that six were professors specializing in childrens' orthopedics, four were board-certified orthopedists, and five were pediatricians. An increased acetabular index, subluxation, and early dislocation may not always be detected on physical examination. delayed diagnosis of dislocation is not evidence that an inadequate physical examination was performed. An increased acetabular index may allow the femoral head to move laterally out of the acetabulum and become a delayed dislocation. The delayed subluxed or dislocated hip constitutes an entity not necessarily related to the neonatal subluxable or dislocatable hip.- - - - - - - - - - ranking = 3keywords = physical examination, physical (Clic here for more details about this article) |
5/6. "Missed" or late-diagnosed congenital dislocation of the hip. A clinical entity.Reported series of neonatal examinations of the hip by trained orthopedic surgeons reveal cases of dislocation of the hip discovered many months after the previous normal examination. The possibility of delayed dislocation of the hip needs further study and its recognition is important for the medical and legal professions. physicians may be blamed erroneously for failure to diagnose CDH at an early stage. In 10 documented cases, early examinations by qualified experts revealed normal hip findings, although the patients were later discovered to have CDH. In five instances, the physical examinations were done by specialists in children's orthopedics. In one case of a child being examined for knock-knee, x-rays accidently included the hips and showed CDH. Thus, clinical signs are not infallible and an occasional case will be missed on examination even in children older than one year. Congenital dysplasia of the hip is a dynamic process and parents should be warned of the possibility of delayed dislocation. Repeated examinations of the hips are recommended.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/6. A newborn with bilateral hip flexion contractures and clubfeet.The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopaedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on the first page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.- - - - - - - - - - ranking = 0.059496736690809keywords = physical (Clic here for more details about this article) |