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

Follow-up after successful treatment for developmental dysplasia of the hip using a Pavlik harness : is two years enough?

Aims

The length of time for which children, who are treated successfully for developmental dysplasia of the hip (DDH) in a Pavlik harness should be followed up, remains uncertain. The aim of this study was to examine whether children who are treated in this way, who have normal clinical and radiological findings at the age of two years, can be safely discharged from routine follow-up.

Methods

Data were collected prospectively on all 101 children (170 hips) who were treated in a Pavlik harness in our children's hospital between January 2015 and June 2016, with follow-up to the age of five years. Demographic, clinical, and radiological parameters were recorded. Routine anteroposterior radiographs of both hips were taken at the age of one, two and five years. A normal radiograph of the hip was defined as one with an acetabular index (AI) within the normal range when adjusted for age, symmetrical and adequately sized ossific nuclei, an International Hip Dysplasia Institute grade of 1 and a centre-edge angle (CEA) of > 20°.

Results

Of the 101 children (170 hips) who were successfully treated in this way and had radiographs available for analysis from the three timepoints, 157 hips (92%) were normal radiologically at the age of two years and all were normal radiologically at the age of five years. Every child who had normal radiographs at the age of two years had normal clinical and radiological findings at five years, with none having any intervention.

Conclusion

These findings support the suggestion that, following successful treatment with a Pavlik harness, children with DDH can be safely discharged from the clinic, assuming that they are clinically and radiologically normal, at the age of two years instead of five.

Utility of routine X-ray surveillance following hip sonography for developmental dysplasia in children: a single-center study spanning a decade

INTRODUCTION

This study evaluates the necessity of routine X-ray follow-ups in children with developmental dysplasia of the hip (DDH), identified through Graf hip ultrasound, a standard component of screening in Germany. The purpose of this study was to investigate the occurrence of radiological deterioration in hips that were initially diagnosed and treated according to established guidelines within a university-based risk-enriched cohort and to identify associated risk factors.

MATERIALS AND METHODS

Patients diagnosed with developmental DDH from 2009 to 2018 with sonographically healthy hips (alpha > 64°) post conservative therapy and at least one follow-up X-ray by the age of two were analysed. Patients with significant comorbidities, syndromes, malformations, non-compliance with treatment, or missing X-ray data were excluded. Descriptive analysis of sonography, X-ray, and patient records were followed by univariate analysis and subsequent multiple logistic regression, identifying risk factors for severe and extreme dysplasia in X-rays.

RESULTS

Of the 450 included hips, 254 were classified as Graf Type 2a or higher, leading to treatment. Subsequent X-rays revealed severe dysplasia in 53 hips and extreme dysplasia in seven hips. Univariate analysis identified sex, initial Graf-Type, therapy type and duration as significantly associated with pathological radiographs. A regression model identified the initial Graf type as the predominant predictor with hip types 3a and 4, cast therapy and overhead extension as independent predictors.

CONCLUSIONS

The data demonstrate pathological findings even after successful conservative treatment of DDH. Worsening of X-ray findings appear less frequent in mild dysplasia. These insights support routine radiographic follow-up assessments after successful conservative therapy. However, further dedicated studies are needed to determine whether patients with initially normal radiographs require radiographic follow-up.

Spinal presentations in children with spinal muscular atrophy type 1 following gene therapy treatment with onasemnogene abeparvovec - The SMA REACH UK network experience

Spinal muscular atrophy (SMA) is a neuromuscular disorder of mainly early onset and variable severity. Prior to the introduction of disease modifying therapies (DMTs), children with SMA type 1 typically died before 2 years of age and management was primarily palliative. Onasemnogene abeparvovec (OA), nusinersen, and risdiplam are novel DMTs which ameliorate the effects of the underlying genetic defect at least partially making SMA a treatable condition. Survival and achievement of previously unmet developmental milestones result in treated SMA type 1 children spending more time upright than expected based on the natural history of the treatment-naïve condition. Consequently, spinal asymmetry and kyphosis, features not typically seen in untreated SMA type 1 children due to early mortality, are increasingly common complications. Precise data regarding their prevalence, severity, and management are currently limited. This study describes the spinal features and management in 75 children with SMA type 1 who received OA between March 2021 and December 2022. Retrospective analysis from SMA REACH UK data showed that 44/75 (59 %) clinically had spinal asymmetry and 37 (49 %) had kyphosis. This study aims to raise awareness of this important feature as part of the changed natural history of SMA type 1 post OA treatment.

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.