Repeated Pelvic Radiographs in Infants, After Harness Treatment for Developmental Dysplasia of the Hip, Carry Very Low Radiation Risk

Acetabular index as an indicator of Pavlik harness success in grade I developmental dysplasia of the hip: A retrospective study

Purpose

Some articles have focused on the effectiveness of the Pavlik harness treatment for unstable and dislocated hips, yet data on monitoring its effectiveness with the acetabular index remains elusive. Therefore, this study aimed to assess Pavlik harness effectiveness in infants ≤6 months diagnosed with grade I developmental dysplasia of the hip using acetabular index improvement and identify the possible predictors of successful Pavlik harness treatment.

Methods

A retrospective review of infants with grade I acetabular dysplasia treated with a Pavlik harness and monitored with anteroposterior pelvis X-rays at presentation and follow-up. Successful treatment was defined as achieving an acetabular index <30°.

Results

A total of 231 infants with acetabular dysplasia were treated with a Pavlik harness. A successful outcome was achieved in 135 infants (58.4%). Younger age, lower initial acetabular index, and patients with unilateral developmental dysplasia of the hip were significant predictors of a successful outcome. An age of 4.5 months or older was found to be the threshold for an unsuccessful result following Pavlik harness treatment, with a sensitivity of 65.2% and specificity of 57.3%. An initial acetabular index of 35.5° was found to be the threshold for an unsuccessful result, with a sensitivity of 83.7% and specificity of 61.5%.

Conclusion

Pavlik Harness's success in correcting the acetabular index in acetabular dysplasia patients was related to unilateral cases, a younger age at presentation, and a lower initial acetabular index. The thresholds for unsuccessful treatment were an age of 4.5 months or greater and an acetabular index of 35.5° or higher.

Radiological long-term follow-up up to 12 years of initially ultrasound unstable hip types D, III and IV after treatment with the Tübingen splint worn as a plaster

INTRODUCTION

The treatment of ultrasound unstable hips with the Tübingen splint is currently under discussion. However, there is a lack of long-term follow-up data. This study presents to the best of our knowledge first radiological mid-term to long-term data of the successful initial treatment with the Tübingen splint of ultrasound unstable hips.

MATERIALS AND METHODS

From 2002 to 2022 the treatment of ultrasound unstable hips type D, III and IV (age ≤ 6 weeks, no severe limitation of abduction) with the Tübingen splint worn as a plaster is evaluated. Based on data derived from routine X-rays during the follow-up period, a radiological follow-up (FU) analysis until the age of 12 years was performed. The acetabular index (ACI) and center-edge angle (CEA) were measured and classified according to Tönnis as normal findings (NF), slightly (sliD) or severely dysplastic (sevD).

RESULTS

193 of 201 (95.5%) unstable hips could be successfully treated showing normal findings with an alpha angle > 65°. The few patients showing treatment failures were successfully treated applying a Fettweis plaster (human position) under anesthesia. The radiological FU of 38 hips showed a favorable trend with increase of normal findings from 52.8% to 81.1% and decrease of 38.9% to 19.9% of sliD respectively 8.3% to 0% of sevD hips. The analysis of avascular necrosis of the femoral head showed 2 cases (5.3%) of grade 1 according to Kalamchi and McEwen, which were improving over time in the further course.

CONCLUSIONS

The Tübingen splint as alternative to replace a plaster has proven a successful therapeutic option for ultrasound unstable hips type D, III and IV with favorable and over time improving radiological parameter up to the age of 12 years.

The most typical mistakes made during pelvic X-ray in pediatric patients typical mistakes made during pelvic X-ray

Aim: This study aimed to identify the most common mistakes made during pelvic radiography in pediatric patients and to give advice to physicians and technicians on how to avoid these mistakes. Material and Method:Between 2016 and 2020, 1150 pelvic radiographs (in pediatric patients for any reason) were analyzed by two independent orthopaedic surgeons. Radiographs taken in trauma patients were not included in the study due to the patient's discomfort and agitation. Interobserver and intraobserver reliability for radiographic measurements were determined using intra-class correlation coefficients (ICC) obtained from three replicate sets of measurements on a sample of 1150 radiographs recorded by each observer at least one week apart. Results: The mean age of the patients included in this study was 4.28±3.86 (range: 0-14) years. Of the 1150 patients, 935 (81.30%) were female and 215 (18.69%) were male. When pediatric pelvic radiographs were evaluated, the most common mistake was made during gonad protection. It was found that 71.22% of the patients' gonads could not be protected. While this rate was 82.24% in female patients, this rate was 23.34% in male patients. There was a statistically significant difference when compared by gender (p= 0.015). Giving the malposition was the second most common mistake. Conclusion: The most common errors in pediatric pelvic radiographs are failure to provide gonad protection and malposition of the patient. To minimize these errors, it is necessary to inform both the doctor and the technician.