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Arenas-Díaz AL, Guzmán-Martín CA, Ordaz-Robles T, Barrón-Torres EA, Haces-García F, Dabaghi-Richerand A. Protective effect of modified lange "second position" for developing avascular necrosis following closed reduction for developmental dysplasia of the hip. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05488-y. [PMID: 39105840 DOI: 10.1007/s00402-024-05488-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/25/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Developmental Dysplasia of the Hip (DDH) is a condition affecting hip joint development in children, presenting multiple manifestations. Immobilization methods to ensure hip concentricity, such as the human position and modified Lange position, vary in effectiveness and risks, especially avascular necrosis. The purpose of this study was to identify whether closed reduction (CR), with two different immobilization techniques, is effective in avoiding complications such as residual hip dysplasia (RHD), re-dislocation, and Avascular Necrosis (AVN). METHODS A total of 66 patients with DDH (84 hips) were treated with two different techniques of immobilization (groups A and B); the mean age at the time of reduction was 8 (6-13) months. The rates of RHD, Re-dislocation, and AVN were determined with a minimum follow-up of 48 months in both techniques. RESULTS The Chi-square analysis conducted across the study groups unveiled that patients in Group B demonstrated a protective effect against AVN compared to those in Group A (OR: 0.248, 95% CI: 0.072-0.847, p = 0.026). However, no statistically significant differences were found between the groups concerning RHD (p = 0.563) and re-dislocation (p = 0.909). CONCLUSIONS After the initial Human Position immobilization, the second cast with the modified Lange "second position" demonstrated a protective effect compared with maintaining the Human Position immobilization throughout the immobilization period, reducing the likelihood of AVN development in patients undergoing closed reduction for developmental dysplasia of the hip.
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Affiliation(s)
- Ana Laura Arenas-Díaz
- Medical Staff, Foot and Ankle and Cerebral Palsy Clinic, Shriners Hospital for Children, Av. Del Iman No. 257. Pedregal de Santa Úrsula, Coyoacán, 09820, Mexico.
| | | | - Thania Ordaz-Robles
- Research Programs Department, Shriners Hospital for Children, Coyoacán, Mexico
| | | | - Felipe Haces-García
- Medical Direction, Medical Staff Director, Shriners Hospital for Children, Coyoacán, Mexico
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Charles-Lozoya S, Chávez-Valenzuela S, Cobos-Aguilar H, Manilla-Muñoz E, De La Parra-Márquez ML, Arriaga-Cazares HE, García-Hernández A. Closed reduction evaluation in dysplastic hip with the Ömeroğlu system in children aged 24 to 36 months. Medicine (Baltimore) 2023; 102:e32649. [PMID: 36862899 PMCID: PMC9981428 DOI: 10.1097/md.0000000000032649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/22/2022] [Indexed: 03/04/2023] Open
Abstract
Closed reduction (CR) as an initial treatment for developmental hip dysplasia of the hip (DDH) in children aged 24 to 36 months is debatable; however, it could have better results than open reduction (OR) or osteotomies, because it is minimally invasive. The purpose of this study was to evaluate the radiological results in children (24-36 months) with DDH initially treated with CR. Initial, subsequent, final anteroposterior pelvic radiological records were retrospectively analyzed. The International Hip Dysplasia Institute was used to classify the initial dislocations. To evaluate the final radiological results after CR (initial treatment) or additional treatment (CR failed), the Ömeroğlu system was used (6 points excellent, 5 good, 4 fair-plus, 3 fair-minus, and ≤2 poor). The degree of acetabular dysplasia was estimated using the initial acetabular index and the final acetabular index, Buchholz-Ogden classification was used to measure avascular necrosis (AVN). A total of 98 radiological records were eligible, including 53 patients (65 hips). Fifteen hips (23.1%) were redislocated, OR with femoral osteotomy and pelvic osteotomy was the preferred surgical treatment 9 (13.8%). The initial acetabular index versus final acetabular index in total population was (38.9º ± 6.8º) and (31.9º ± 6.8º), respectively (t = 6.5, P < .001). The prevalence of AVN was 40%. Overall AVN in OR, femoral osteotomy and pelvic osteotomy were 73.3% versus CR 30%, P = .003. Unsatisfactory results ≤ 4 points on the Ömeroğlu system were observed in hips that required OR with femoral and pelvic osteotomy. Hips with DDH treated with CR initially might had better radiological results than those treated with OR and femoral and pelvic osteotomies. Regular, good, and excellent results, ≥4 points on the Ömeroğlu system, could be estimated in 57% of the cases, in whom CR was successful. AVN is frequently observed in hips with failed CR.
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Affiliation(s)
- Sergio Charles-Lozoya
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS). Monterrey, N.L., México
- Health Science Division, Vice-rectory of Health Science, Universidad de Monterrey, San Pedro Garza Garcia N.L., México
| | - Salvador Chávez-Valenzuela
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS). Monterrey, N.L., México
| | - Héctor Cobos-Aguilar
- Health Science Division, Vice-rectory of Health Science, Universidad de Monterrey, San Pedro Garza Garcia N.L., México
| | - Edgar Manilla-Muñoz
- Health Science Division, Vice-rectory of Health Science, Universidad de Monterrey, San Pedro Garza Garcia N.L., México
| | - Miguel Leonardo De La Parra-Márquez
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS). Monterrey, N.L., México
| | - Héctor Eliud Arriaga-Cazares
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS). Monterrey, N.L., México
| | - Adrián García-Hernández
- Health and Research Science Management, Pediatric Orthopedic Surgery, Division of Plastic and Reconstructive Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS). Monterrey, N.L., México
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Zhang G, Li M, Qian H, Wang X, Dang X, Liu R. Coronal and sagittal spinopelvic alignment in the patients with unilateral developmental dysplasia of the hip: a prospective study. Eur J Med Res 2022; 27:160. [PMID: 36030216 PMCID: PMC9419408 DOI: 10.1186/s40001-022-00786-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND How the hip dysplasia affects the spinopelvic alignment in developmental dysplasia of the hip (DDH) patients is unclear, but it is an essential part for the management of this disease. This study aimed to investigate the coronal and sagittal spinopelvic alignment and the correlations between the spinopelvic parameters and the extent of hip dysplasia or the low back pain in unilateral DDH patients. METHODS From September 2016 to March 2021, 22 unilateral patients were enrolled in the DDH group with an average age of 43.6 years and 20 recruited healthy volunteers were assigned to the control group with an average age of 41.4 years. The Cobb angle, seventh cervical vertebra plumbline-central sacral vertical line (C7PL-CSVL), third lumbar vertebra inclination angle (L3IA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK) and lumbar lordosis (LL) were measured on the standing anteroposterior and lateral full-length standing spine radiographs. Additionally, the Oswestry Disability Index (ODI) and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were used to assess the degree of low back pain. RESULTS Cobb angle (8.68 ± 6.21° vs. 2.31 ± 0.12°), L3IA (4.80 ± 5.47° vs. 0.83 ± 0.51°), C7PL-CSVL (1.65 ± 1.57 cm vs. 0.48 ± 0.33 cm), PT (15.02 ± 9.55° vs. 9.99 ± 2.97°) and TLK (7.69 ± 6.66° vs. 3.54 ± 1.63°) were significantly larger in DDH patients, whereas LL (37.41 ± 17.17° vs. 48.79 ± 7.75°) was significantly smaller (P < 0.05). No correlation was found between significantly different spinopelvic parameters and the extent of dysplasia. Statistical analysis revealed correlations between ODI and Cobb angle (r = 0.59, P < 0.01), PT (r = 0.49, P = 0.02), TK (r = -0.46, P = 0.03) and TLK (r = 0.44, P = 0.04). Correlations between JOABPQE score and the Cobb angle (r = -0.44, P = 0.04), L3IA (r = -0.53, P = 0.01), PT (r = -0.44, P = 0.04), and TK (r = 0.46, P = 0.03) were also observed. CONCLUSIONS Cobb angle, L3IA, C7PL-CSVL in coronal plane and PT, TLK in sagittal plane increased, while LL decreased in unilateral DDH patients. These significantly different spinopelvic parameters have no correlation with the extent of dysplasia. Changes in coronal and sagittal plane including Cobb angle, L3IA, PT, TK and TLK were associated with the low back pain in the patients with unilateral DDH.
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Affiliation(s)
- Guangyang Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157, Xiwu Road, Xi'an, Shaanxi Province, 710004, People's Republic of China
| | - Mufan Li
- Department of Orthopaedics, Chengdu Second People's Hospital, Chengdu, Sichuan Province, 610000, People's Republic of China
| | - Hang Qian
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157, Xiwu Road, Xi'an, Shaanxi Province, 710004, People's Republic of China
| | - Xu Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157, Xiwu Road, Xi'an, Shaanxi Province, 710004, People's Republic of China
| | - Xiaoqian Dang
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157, Xiwu Road, Xi'an, Shaanxi Province, 710004, People's Republic of China
| | - Ruiyu Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, NO.157, Xiwu Road, Xi'an, Shaanxi Province, 710004, People's Republic of China.
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Sioutis S, Kolovos S, Papakonstantinou ME, Reppas L, Bekos A, Koulalis D, Mavrogenis A. Developmental dysplasia of the hip: a review. J Long Term Eff Med Implants 2022; 32:39-56. [DOI: 10.1615/jlongtermeffmedimplants.2022040393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Cai Z, Piao C, Zhang T, Li L, Xiang L. Accuracy of CT for measuring femoral neck anteversion in children with developmental dislocation of the hip verified using 3D printing technology. J Orthop Surg Res 2021; 16:256. [PMID: 33853657 PMCID: PMC8045201 DOI: 10.1186/s13018-021-02400-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 01/25/2023] Open
Abstract
Background Accurate femoral neck anteversion angle (FNA) measurement is of great significance in the diagnosis and treatment of developmental dysplasia of the hip (DDH) in children. The FNA measurement still remains a controversy. We aimed to verify the accuracy of our CT method by 3D printing technology and to evaluate its clinical value. Methods Sixty-eight children with unilateral DDH were enrolled, and their FNA was measured using 2D-CT and 3D-CT, respectively, by three observers. This procedure was repeated 3 months later. The above measurement outcomes were then compared with the results in the 3D-printed femur (3D-PF) model. The FNA in the 3D-PF model was measured by three observers (two radiologists and one orthopedist; all were professors) collectively through electronic angle instrument. Results The primary measurement of FNA at the affected hips by 2D-CT was 44.0 ± 6.1, 49.5 ± 8.9, and 52.8 ± 7.9°, respectively. On the 3D-CT, it was 47.6 ± 5.4, 49.3 ± 6.8, and 48.6 ± 6.2°. Three months later, the FNA on 2D-CT was 49.3 ± 10.5, 42.8 ± 7.4, and 45.1 ± 9.3°, and it was 48.0 ± 6.5, 48.9 ± 7.2, and 49.0 ± 5.7° on 3D-CT, respectively. The FNA in the 3D-PF model at the affected and unaffected hips was 48.5 ± 6.6 and 36.9 ± 13.1°. There were significant differences between 2D-CT and 3D-PF measurements, but no significant difference was found between 3D-CT and 3D-PF measurements. The results by 2D-CT showed significant differences among groups and between the groups. However, the results by 3D-CT had no significant differences among groups or between the groups. Conclusion The results of our study showed that 3D-CT is a more precise, and reproducible method for FNA measurement in DDH. The FNA at the affected hips is 11.6° larger than the unaffected in DDH children aged 3–8 years.
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Affiliation(s)
- Zhencun Cai
- Department of Orthopaedics Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China.,Department of Orthopaedics Surgery, Central Hospital of Shenyang Medical College, Shenyang, Liaoning Province, China
| | - Chengzhe Piao
- Department of Orthopaedics Surgery, Central Hospital of Shenyang Medical College, Shenyang, Liaoning Province, China
| | - Tianyu Zhang
- Department of Orthopaedics Surgery, Central Hospital of Shenyang Medical College, Shenyang, Liaoning Province, China
| | - Lianyong Li
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Liangbi Xiang
- Department of Orthopaedics Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China.
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Li H, Shu L, Yu J, Xian Z, Duan H, Shu Q, Ye J. Using Z-score to optimize population-specific DDH screening: a retrospective study in Hangzhou, China. BMC Musculoskelet Disord 2021; 22:344. [PMID: 33845817 PMCID: PMC8042719 DOI: 10.1186/s12891-021-04216-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND DDH (Developmental Dysplasia of the Hip) screening can potentially avert many morbidities and reduce costs. The debate about universal vs. selective DDH ultrasonography screening in different countries revolves to a large extent around effectiveness, cost, and the possibility of overdiagnosis and overtreatment. In this study, we proposed and evaluated a Z-score enhanced Graf method to optimize population-specific DDH screening. METHODS A total of 39,710 history ultrasonography hip examinations were collected to establish a sex, side specific and age-based Z-scores model using the local regression method. The correlation between Z-scores and classic Graf types was analyzed. Four thousand two hundred twenty-nine cases with follow-up ultrasonographic examinations and 5284 cases with follow-up X-ray examinations were used to evaluate the false positive rate of the first examination based on the subsequent examinations. The results using classic Graf types and the Z-score enhanced types were compared. RESULTS The Z-score enhanced Graf types were highly correlated with the classic Graf's classification (R = 0.67, p < 0.001). Using the Z-scores ≥2 as a threshold could reduce by 86.56 and 80.44% the false positives in the left and right hips based on the follow-up ultrasonographic examinations, and reduce by 78.99% false-positive cases based on the follow-up X-ray examinations, respectively. CONCLUSIONS Using an age, sex and side specific Z-scores enhanced Graf's method can better control the false positive rate in DDH screening among different populations.
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Affiliation(s)
- Haomin Li
- Clinical Data Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Binsheng Road 3333#, Hangzhou, 310052, China.
| | - Liqi Shu
- Rhode Island Hospital, Brown University, Providence, USA
| | - Jin Yu
- Department of Ultrasound, The Children's Hospital, Zhejiang University School of Medicine, Binsheng Road 3333#, Hangzhou, 310052, China
| | - Zeng Xian
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Huilong Duan
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Qiang Shu
- Clinical Data Center, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Binsheng Road 3333#, Hangzhou, 310052, China
| | - Jingjing Ye
- Department of Ultrasound, The Children's Hospital, Zhejiang University School of Medicine, Binsheng Road 3333#, Hangzhou, 310052, China.
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Atalar H, Gunay C, Turanli S, Koktener A. Discrepancy between ultrasonographic and radiographic findings in patients treated for developmental dysplasia of the hip; hip maturation on ultrasonography may not be consistent with radiographic hip maturation. J Pediatr Orthop B 2020; 29:228-234. [PMID: 31305360 DOI: 10.1097/bpb.0000000000000654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Currently, hip sonography is used for early diagnosis and for monitoring developmental dysplasia of the hip (DDH) treatment in many countries. An early pioneer of ultrasonography for early diagnosis of DDH was Graf. Based on the Graf approach, hip ultrasonography is more sensitive and specific than radiography for the diagnosis of DDH, because of its capability to show cartilaginous structures of the hip joint. The aim of this study was to compare radiographic and ultrasonographic findings in patients treated for DDH. This study included 88 infants (98hips) treated for DDH. Radiography was simultaneously used for treatment and follow-up evaluation in addition to ultrasonography after six months of age. A retrospective evaluation was made of the ultrasonographs and radiographs of these infants. Of the total 98 hips, 28 were normal both ultrasonographically and radiographically, and a pathologic hip was demonstrated in 32 hips both sonographically and radiographically. Hip ultrasonography showed abnormal development in 32 hips, while radiography showed abnormal development in 70 hips. In 38 hips, the findings were normal according to ultrasonography but pathological according to radiography. There were no hips that were normal radiographically but pathological sonographically. When radiography is accepted as the standard imaging method in our study patients, the sensitivity and specificity of hip ultrasonography were determined as 45.7% [95% confidence interval (CI): 41.5-45.7] and 100% (95% CI: 89.4-100), respectively. These findings suggest that hip maturation apparent on ultrasonography may not be consistent with radiographic hip development in infants treated for DDH.
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Affiliation(s)
- Hakan Atalar
- Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine
| | - Cuneyd Gunay
- Department of Orthopaedics and Traumatology, Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Sacit Turanli
- Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine
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