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Management strategy for prevention of avascular necrosis during treatment of congential dislocation of the hip
ABSTRACTS Management Strategy for Prevention of Avascular Necrosis During Treatment of Congential Dislocation of the Hip.
J. R. Buchanan, R. B. Greer, and J. M. Cotler. J Bone Joint Surg 63A:140-146, (January), 1981. Fifty children with unilateral hip dislocations were studied to see what factors may play a role in the prevention of osteonecrosis. Osteonecrosis was found to occur in 36 patients; the findings appearing within the first 12 mo of reduction. The authors conclude that a m i n i m u m of 2 wk of traction until the femoral head was pulled distal to the acetabulum with subsequent immobilization.in the " h u m a n " position in a spica cast was consistently associated with failure of damage to the vascular supply of the femoral head.--~Anthony H. Alter Problems Encountered in the Early Diagnosis and Management of Congenital Dislocation of the Hip. L G. Mackenzie
and J. G. Wilson. J Bone Joint Surg 63B:38-42, (February), 1981. From an area of Scotland where virtually all deliveries occur in some hospital, the screening of 53,033 babies over a 10-yr period for congenital dislocation of the hip is reported. Having been screened locally, all suspect babies were referred to a special clinic at about 1 mo old, at which stage half the hips were normal and were left untreated and the rest were treated by splintage. All late cases were referred to the same clinic. Of the 53,033 babies 5.37% were found to be abnormal shortly after birth and at 1 mo 2.84% were accepted for treatment. At the same time 0.18% of these children were diagnosed long after the neonatal period, representing a failure in the screening program. An analysis of such failures in diagnosis revealed no significance so far as place of birth, grade or degree or specialization of the doctor was concerned. Failure of management occurred in 38 babies due to failure to confirm at 1 mo the dislocation, which became later apparent or due to inadequate splintage or due to maternal refusal of t r e a t m e n t . - - M . G. H. S m i t h Catterall Grouping of Perthes" Disease. P. H. Hardcastle,
R. Ross, M. Hamalainen, and A. Mata. J Bone Joint Surg 62B:428-431, (November), 1980. The Catterall grouping of Perthes' disease and the assessment of "'at risk" features has been accepted in recent years as a guide to the prognosis in Perthes' disease and to the need for treatment. This study to assess the reliability of such classification was carried out using surgeons and a radiologist interested in Perthes' disease and familiar with the classification. The results show a poor ability to assess Perthes' disease from early radiographs by this group of surgeons compared with the classification given by Catterall himself, except in the severest grade of the disease. Interpretation of "at risk" signs was generally unsatisfactory.-M. G. H. Smith Premature Epiphysial Closure in Perthas" Disease. Jr. M.
Barnes. J Bone Joint Surg 62B:432-437, (November), 1980. Although a rare complication of Perthes' disease, premature closure of the epiphysial plate is reported in 22 children, nearly all of whom had been treated by upper femoral varus a n d / o r rotation osteotomy. The possibility of the osteotomy
773
being a precipitating cause either by trying to enforce containment of an already deformed head at a late stage in the disease, or by causing a breach in the epiphysial plate during the osteotomy, or by imperilling the blood supply further with osteotomy and plaster fixation early in the disease are discussed.--M. G. H. S m i t h The Sagging Rope Sign in Perthes" Disease and Allied Disorders. A. Graham Apley and S. Wientroub. J Bone Joint
Surg 63B:43-47, (February), 1981. The appearance of a line of increased radiologic opacity, concave cranially, within the femoral neck is described. Although this has most often been recognized in Perthes' disease of severe degree with a short thick femoral neck, a flattened head and with premature closure of the growth plate, it has also been seen in congenital dislocation of the hip with epiphysitis of the femoral head. With the appearance of this line, greater trochanteric overgrowth m a y be found. In this respect the appearance of such a line may be regarded as an indication for trochanteric epiphyseodesis to prevent overgrowth.--M. G. H. S m i t h A Controlled Study of the Results of Femoral Osteotomy in Severe Perthes" Disease. A. T. Canario, L. Williams, S.
Wientroub, A. Catterall, and G. C. Lloyd-Roberts. J Bone Joint Surg 62B:438 440, (November), 1980. Sixty-three hips with severe Perthes' disease subjected to osteotomy to produce containment have been compared with a controlled group of 85 untreated hips. The results show a clear superiority for the osteotomy group (50% good results compared with 14% in the control group). T h e authors also find that an early age of onset of Perthes' disease should not be regarded as a contraindication for operation. Some disturbance in leg length by the varus component of the osteotomy was found but this was not excessive.--M. G. H. S m i t h Slipped Capital Femoral Epiphysis: Long Term Follow-up Study of One-hundred and Twenty-one Patients, D. HI.
Boyer, M. R. Mickelson and B. Ponsetti. J Bone Joint Surg 63A:85-95, (January), 1981. One-hundred and twenty-one patients, including 93 unilateral and 28 bilateral slipped capital femoral epiphyses were studied; 75 by direct examination and 46 by questionnaire. Follow-up averaged 31 yr with a mean age of follow-up of 45 yr. Eighty-three patients were treated with no effort to realign the displacement. Fifty-four patients had an effort, closed or open, to reduce the displacement with all forms of surgical techniques, including osteotomy. Forty-eight of these operated patients achieved partial or complete reduction of the slip. The 83 hips treated without manipulation included 24 treated with spica cast, 27 with pinning, 18 with crutches, 3 with recumbency, and 12 with no treatment at all. Nearly all patients with mild slips, even with malunion, had close to normal hip ratings. Four of these patients underwent chondrolysis; the complication being attributed to spica cast immobilization. The bulk of patients with moderate slips treated by these various nonreduction techniques also had excellent to good results with no pain and with no limitation of motion. Seven patients with severe uncorrected slips were studied and six had good clinical results on the long term, although they had limited range of motion and
J. R. Buchanan, R. B. Greer, and J. M. Cotler. J Bone Joint Surg 63A:140-146, (January), 1981. Fifty children with unilateral hip dislocations were studied to see what factors may play a role in the prevention of osteonecrosis. Osteonecrosis was found to occur in 36 patients; the findings appearing within the first 12 mo of reduction. The authors conclude that a m i n i m u m of 2 wk of traction until the femoral head was pulled distal to the acetabulum with subsequent immobilization.in the " h u m a n " position in a spica cast was consistently associated with failure of damage to the vascular supply of the femoral head.--~Anthony H. Alter Problems Encountered in the Early Diagnosis and Management of Congenital Dislocation of the Hip. L G. Mackenzie
and J. G. Wilson. J Bone Joint Surg 63B:38-42, (February), 1981. From an area of Scotland where virtually all deliveries occur in some hospital, the screening of 53,033 babies over a 10-yr period for congenital dislocation of the hip is reported. Having been screened locally, all suspect babies were referred to a special clinic at about 1 mo old, at which stage half the hips were normal and were left untreated and the rest were treated by splintage. All late cases were referred to the same clinic. Of the 53,033 babies 5.37% were found to be abnormal shortly after birth and at 1 mo 2.84% were accepted for treatment. At the same time 0.18% of these children were diagnosed long after the neonatal period, representing a failure in the screening program. An analysis of such failures in diagnosis revealed no significance so far as place of birth, grade or degree or specialization of the doctor was concerned. Failure of management occurred in 38 babies due to failure to confirm at 1 mo the dislocation, which became later apparent or due to inadequate splintage or due to maternal refusal of t r e a t m e n t . - - M . G. H. S m i t h Catterall Grouping of Perthes" Disease. P. H. Hardcastle,
R. Ross, M. Hamalainen, and A. Mata. J Bone Joint Surg 62B:428-431, (November), 1980. The Catterall grouping of Perthes' disease and the assessment of "'at risk" features has been accepted in recent years as a guide to the prognosis in Perthes' disease and to the need for treatment. This study to assess the reliability of such classification was carried out using surgeons and a radiologist interested in Perthes' disease and familiar with the classification. The results show a poor ability to assess Perthes' disease from early radiographs by this group of surgeons compared with the classification given by Catterall himself, except in the severest grade of the disease. Interpretation of "at risk" signs was generally unsatisfactory.-M. G. H. Smith Premature Epiphysial Closure in Perthas" Disease. Jr. M.
Barnes. J Bone Joint Surg 62B:432-437, (November), 1980. Although a rare complication of Perthes' disease, premature closure of the epiphysial plate is reported in 22 children, nearly all of whom had been treated by upper femoral varus a n d / o r rotation osteotomy. The possibility of the osteotomy
773
being a precipitating cause either by trying to enforce containment of an already deformed head at a late stage in the disease, or by causing a breach in the epiphysial plate during the osteotomy, or by imperilling the blood supply further with osteotomy and plaster fixation early in the disease are discussed.--M. G. H. S m i t h The Sagging Rope Sign in Perthes" Disease and Allied Disorders. A. Graham Apley and S. Wientroub. J Bone Joint
Surg 63B:43-47, (February), 1981. The appearance of a line of increased radiologic opacity, concave cranially, within the femoral neck is described. Although this has most often been recognized in Perthes' disease of severe degree with a short thick femoral neck, a flattened head and with premature closure of the growth plate, it has also been seen in congenital dislocation of the hip with epiphysitis of the femoral head. With the appearance of this line, greater trochanteric overgrowth m a y be found. In this respect the appearance of such a line may be regarded as an indication for trochanteric epiphyseodesis to prevent overgrowth.--M. G. H. S m i t h A Controlled Study of the Results of Femoral Osteotomy in Severe Perthes" Disease. A. T. Canario, L. Williams, S.
Wientroub, A. Catterall, and G. C. Lloyd-Roberts. J Bone Joint Surg 62B:438 440, (November), 1980. Sixty-three hips with severe Perthes' disease subjected to osteotomy to produce containment have been compared with a controlled group of 85 untreated hips. The results show a clear superiority for the osteotomy group (50% good results compared with 14% in the control group). T h e authors also find that an early age of onset of Perthes' disease should not be regarded as a contraindication for operation. Some disturbance in leg length by the varus component of the osteotomy was found but this was not excessive.--M. G. H. S m i t h Slipped Capital Femoral Epiphysis: Long Term Follow-up Study of One-hundred and Twenty-one Patients, D. HI.
Boyer, M. R. Mickelson and B. Ponsetti. J Bone Joint Surg 63A:85-95, (January), 1981. One-hundred and twenty-one patients, including 93 unilateral and 28 bilateral slipped capital femoral epiphyses were studied; 75 by direct examination and 46 by questionnaire. Follow-up averaged 31 yr with a mean age of follow-up of 45 yr. Eighty-three patients were treated with no effort to realign the displacement. Fifty-four patients had an effort, closed or open, to reduce the displacement with all forms of surgical techniques, including osteotomy. Forty-eight of these operated patients achieved partial or complete reduction of the slip. The 83 hips treated without manipulation included 24 treated with spica cast, 27 with pinning, 18 with crutches, 3 with recumbency, and 12 with no treatment at all. Nearly all patients with mild slips, even with malunion, had close to normal hip ratings. Four of these patients underwent chondrolysis; the complication being attributed to spica cast immobilization. The bulk of patients with moderate slips treated by these various nonreduction techniques also had excellent to good results with no pain and with no limitation of motion. Seven patients with severe uncorrected slips were studied and six had good clinical results on the long term, although they had limited range of motion and