La verificación de la reducción de la cadera utilizando ecografía anterior durante el tratamiento con el arnés de Pavlik de displasia del desarrollo de la cadera / Verification of hip reduction using anterior ultrasound scanning during Pavlik harness treatment of developmental dysplasia of the hip

Fuente
Este artículo es originalmente publicado en:
http://www.ncbi.nlm.nih.gov/pubmed/25561752
http://www.sciencedirect.com/science/article/pii/S0972978X14000725
De:
Carlile GS1Woodacre T1Cox PJ1.
 2014 Sep 26;11(4):174-9. doi: 10.1016/j.jor.2014.08.001. eCollection 2014.
Todos los derechos reservados para:
Copyright © 2015 Elsevier B.V. or its licensors or contributors. ScienceDirect® is a registered trademark of Elsevier B.V.

Abstract

AIM:

Ultrasound scanning (USS) is used for diagnosis and surveillance in developmental dysplasia of the hip (DDH). Lateral coronal scanning is performed with the hip flexed, in neutral adduction. In this position an unstable hip may dislocate, failing to demonstrate a reducible hip, leading to abandonment of harness treatment. Anterior ultrasound permits imaging of the flexed abducted hip in harness. This study evaluates the role of anterior & lateral USS in determining duration of treatment and reduction in DDH.

METHOD:

Between 1997 & 2010, 233 patients requiring harness treatment received lateral USS, with dislocated & dysplastic hips re-imaged fortnightly. From 2005, anterior USS was used additionally to assess reduction in harness.

RESULTS:

One-hundred and eighteen patients (167 hips) received lateral USS, 115 (160 hips) received both. In the lateral cohort, 103 (140 hips) were treated successfully, mean duration 66.2 days (95% CI 60.2-72.1), with 15 (26 hips) failures (15.5%), mean 30 (CI 95% 19.3-40.6). In the anterior cohort, 107 (150 hips) were treated successfully, mean 53.3 (95% CI 49.8-56.7), with 8 (10 hips) failures (6.25%), mean 35.3 (CI 95% 25.5-44.9). Children receiving an anterior USS had a shorter duration of treatment (p = 0.011) and no difference in failures (p = 0.21).

CONCLUSIONS:

A reduced duration of treatment for Graf 3 hips was observed. Anterior ultrasound allows earlier recognition of hips that fail to stabilize, via two observed modes of failure; failure of hip reduction and failure to stabilize after reduction.

KEYWORDS:

Anterior; DDH; Developmental dysplasia of the hip; Scanning; Ultrasound
PMID:

 

25561752

 

[PubMed] 
PMCID:

 

PMC4281631
 [Available on 2015-12-01]

Osteotomía francesa de cúbito varo en niños: un estudio a largo plazo más de 27 años / French Osteotomy for Cubitus Varus in Children: A Long-term Study Over 27 Years

Fuente
Este artículo es originalmente publicado en:
http://www.ncbi.nlm.nih.gov/pubmed/25658180
http://journals.lww.com/pedorthopaedics/pages/articleviewer.aspx?year=9000&issue=00000&article=99628&type=abstract
De:
North D1Held MDix-Peek SHoffman EB.
 2015 Feb 5. [Epub ahead of print]
Todos los derechos reservados para:

Abstract
BACKGROUND::
Cubitus varus is a cosmetically unacceptable complication of supracondylar fractures of the elbow in children. We have performed the lateral closing wedge (French) osteotomy to correct the varus for 27 years. More complex osteotomies have been described to correct the associated hyperextension and internal rotation deformities and to prevent a prominent lateral condyle.
METHODS::
We retrospectively reviewed 90 consecutive patients (1986 to 2012). The mean age of the patients at surgery was 8.2 years (3 to14 y). The varus angle (mean, 21.4 degrees; range, 8 to 40 degrees) was assessed preoperatively with the humero-elbow-wrist angle. The postoperative carrying angle (mean, 10.4 degrees) and the preoperative and postoperative range of movement were assessed clinically. The lateral condylar prominence index (LCPI) was retrospectively measured at union.
RESULTS::
Seventy-five (93.3%) of the patients had a good or excellent result. Six (6.7%) had a poor result (residual varus, loss of >20 degrees of preoperative range of flexion or extension or a complication necessitating resurgery). There were no neurovascular complications. The mean LCPI was +0.14.
CONCLUSIONS::
The results of the French osteotomy are comparable with the more technically demanding dome, step-cut translation, and multiplanar osteotomies, with a lower complication rate. The literature reports adequate remodeling of the hyperextension deformity (≤10 y) and the LCPI (≤12 y), and that the internal rotation deformity is well tolerated by the patient.
LEVEL OF EVIDENCE::
Level IV-case series.

PMID: 25658180 [PubMed – as supplied by publisher]
Resumen
ANTECEDENTES :
El cúbito varo es una complicación cosméticamente aceptable de las fracturas supracondíleas del codo en niños. Hemos realizado la osteotomía en cuña de cierre lateral (francesa) para corregir el varo durante 27 años. Osteotomías más complejas se han descrito para corregir la hiperextensión asociada y deformidades de rotación interna y para evitar un cóndilo lateral prominente.
MÉTODOS :
Se revisaron retrospectivamente 90 pacientes consecutivos (1986-2012). La edad media de los pacientes en la cirugía fue de 8,2 años (3 a 14 y). El ángulo varo (media, 21,4 grados, rango, 8-40 grados) se evaluó antes de la operación con el ángulo húmero-codo-muñeca. El ángulo postoperatoria en libros (media, 10,4 grados) y el preoperatorio y postoperatorio rango de movimiento fueron evaluados clínicamente. El índice de la prominencia del cóndilo lateral (LCPI) se midió de forma retrospectiva en la unión.
RESULTADOS :
Setenta y cinco (93,3%) de los pacientes tuvieron un resultado bueno o excelente. Seis (6,7%) tuvieron un mal resultado (varo residual, pérdida de> 20 grados de rango preoperatoria de flexión o extensión o una re-operación, complicación que requiere). No hubo complicaciones neurovasculares. La media LCPI era 0,14.
Conclusiones :
Los resultados de la osteotomía francesa son comparables con el techo más exigente técnicamente, traducción corte del paso-y osteotomías multiplanares, con una menor tasa de complicaciones. La literatura informa remodelación adecuada de la deformidad hiperextensión (≤10 y) y la LCPI (≤12 y), y que la deformidad rotación interna es bien tolerado por el paciente.
NIVEL DE EVIDENCIA ::
Nivel serie IV-caso.