Sonography of the neonatal and infant hip

INTERNATIONAL ABSTRACTS

The authors have designed a procedure of splitting the posterior tibial tendon and transferring its posterior half laterally to the peroneus brevis tendon for spastic children with acquired equinovarus deformity. Eleven patients were studied, with follow-up averaging eight years. Twenty-six of these children were skeletally mature at the time of surgery. Thirty patients had excellent results, and the procedure allowed them to become brace-free with functioning dorsiflexion of the foot. Two failures were in hemiplegic patients who had recurrent deformities. Complications included a case of skin flap necrosis, superficial infections, and two pressure sores. The authors comment that when the procedure was done in other kinds of paralytic equinovarus, the results were not satisfactory. They, therefore, have limited the indications of the procedure to patients with cerebral palsy spasticity.--Anthony H. Alter Varus Derotation Osteotomy and Treatment of Persistent Dysplasia and Congenital Dislocation of the Hip. J.R. Kasser, J.R. Bowen,

and G.D. MacEwen. J Bone Joint Surg 67A:195-202, (February), 1985. Thirty-four patients had varus derotation osteotomies for persistent hip dysplasia as a function of congenital hip dislocation. Follow-up averaged 10.3 years. The cases were studied from the time of surgery for the influence of femoral remodelling, acetabular response, and presence of pre-existing osteonecrosis as it affected the final results. The results were consistently good in youngsters operated on before the age of four. Acetabular remodelling could still occur up until the age of eight. However, it may not be complete. Eight patients over the age of ten had no significant benefit from the procedure. Pre-existing osteonecrosis made the results worse. Remodelling predictably occurred until the age of eight but was irregular thereafter. No remodelling went to the point of recurrent valgus. Complications included three lateral physeal arrests, one of whom went on to progressive subluxation. There was failure of fixation in two patients. This is a definitive review of the role of the osteotomy for residual hip dysplasia. Anthony H. Alter Sonography of the Neonatal and Infant Hip. G. Novick, B. Ghelman, and M. Schneider. Am J Roentgenol 141:639-645, (October), 1983.

Using real-time sonography, 36 examinations of the hip in 33 patients (newborn to 1 year) and in 20 controls are described. The remaining 13 patients presented with clinical signs of CHD (4), known CHD (5), conditions predisposing to CHD (3), or septic dislocation (1). In the medial transverse view, the cartilaginous femoral head appears as a hypoechoic circle containing tiny punctate bright echoes. The ossified acetabulum can be seen, and with rotation of the femur the relationship between the femoral head and acetabulum can be demonstrated. The lateral transverse view also demonstrates this relationship and may detect the triradiate cartilage of the acetabulum. Normality can be quickly established by these examinations. True dislocations require longer examinations due to absent anatomic landmarks. The authors feel that sonography offers the only technique to directly visualize the relationship between the femoral head and acetabulum with maximum safety and lack of radiation exposure. The study is also useful for follow-up examinations to evaluate results of therapy. Randall W. Powell Long-Term Results of Open Sternocleidomastoid Tenotomy for Idiopathic Muscular Torticollis. E. /ppolito, C. Tudesco, and

M. Massobrio. J Bone Joint Surg 67A:30-38, (January), 1985. Sixty-seven patients surgically treated with open distal tenotomy of the sternocleidomastoid for idiopathic muscular torticollis were studied. The average follow-up was 15.4 years. The analysis was

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based upon a study of residual facial asymmetry, restriction of range of motion, absence of head tilt, and the presence of residual lateral bands or loss of the sternocleidomastoid column. Fourteen of 23 patients operated on within the first six years had good results whereas eight of 13 patients operated after 12 years of age had poor results. The study corroborates that the longer the syndrome persists, the poorer the cosmetic and functional results. No comment is made concerning surgical complications.--Anthony H. Alter Acute Osteomyelitis and Septic Arthritis in Children: A Simple Approach to Treatment. I.D. Learmonth, G. Dall, and D.J. Pollock.

So Afr Med J 65:117-120, (January), 1984. A 12-month prospective study of 45 patients with bacteriologically proven acute osteitis and septic arthritis is presented. Sodium fusidate and erythromycin at the recommended dosage of 30 mg/ kg/24 hrs for 3 weeks was found to be an effective first line antibiotic regimen. The hazards of Haemophilus infection are emphasized. Early surgical exploration of all suspected cases is recommended. Immediate gram staining of pus obtained at surgery is strongly advised. It was found that adequate drainage of a subperiosteal abscess without drilling the bone always resulted in complete cure, while cases of septic arthritis consequent upon decompression of a contiguous metaphysis were adequately treated by arthrotomy and irrigation alone. Early circumspect mobilization was instrumental in achieving good rehabilitation. Results, both cosmetic and functional, were graded as excellent in 87% at 12 months follow-up.--A.J.W. Millar N E R V O U S SYSTEM Influence of Prognosis on Decisions Regarding the Care of Newborns with Myelodysplasia. J.F. McLaughlin, D.B. Shurtleff,

J.Y. Lamers, et al. N Engl J Med 312:1589 1593, (June 20), 1985. The authors describe their experience with 212 infants with myelodysplasia seen between January 1965 and December 1982. The infants were grouped according to initial assessment of prognosis and care: (I) good prognosis and early surgical treatment (127 patients); (2) poor prognosis and supportive treatment (56 patients); (3) poor prognosis and early surgical treatment (29 patients). Criteria used for determining poor prognosis included (1) large thoracic and high lumbar lesions with accompanying cord paralysis; (2) the presence of additional life threatening problems or malformations requiring extraordinary treatment; (3) advanced hydrocephalus with head circumference larger than two standard deviations above the mean at birth or the presence of less than 1 cm of frontal cerebral mantel; (4) central nervous system hemorrhage or infection; (5) social circumstances that preclude emotional nurturing for the infant. Early surgical care was performed regardless of the prognosis whenever the parents requested, and a court order was sought on behalf of the neonate whenever parents requested only supportive care despite an apparently good prognosis. Careful follow-up was obtained in all patients. Because of changes in techniques and management over the years of study, patients were divided into three groups temporally: 1965 to 1970 (53 patients); 1971 to 1976 (65 patients); 1977 to 1982 (94 patients). An increased percentage of neonates (42% v 71%) received a good prognosis in the more recent period. Among neonates with a poor prognosis six of 31 received early surgery in the first period, while 14 of 27 received surgery in the later period. There was a significant difference in survival between surgically treated children and those receiving only supportive care in all three time periods. There was no significant differenee in survival between patients in the good prognosis and poor prognosis groups who received early surgical treatment. There was a significant difference in functional outcome favoring the good