critical analysis of the protocol for the conservative treatment of developmental dysplasia of the hip in Kuwait

To evaluate the results of conservative t reatment of developmental dysplasia of the hip to determine which is the most effective treatment in terms of rates of complications as well as from an economical point of view, to prevent unnecessarily long hospital stays. The results of conservative treatment for developmental dysplasia of the hip are evaluated after an average follow-up of four years in 69 patients and 99 hips [31 bilateral, 23 left side, and 14 right side]. All patients were treated at Kuwait's Al-Razi Hospital between January 1995 and December 1996. There were 59 females and 10 males, aged between 5 and 24 months [median: 12 months]. The treatment consisted of traction for 1 to 2 weeks followed by manipulation in 36 hips; manipulation with adductor longus tenotomy in 45 hips; and with adductor longus and psoas tenotomy in 18 hips. Avascular necrosis of the femoral head developed in 16 hips [16%]; 14 hips on the affected side and two hips on the unaffected side. Persistent acetabular dysplasia was present in 13 hips, subluxation in nine hips and dislocation in 13 hips. Open reduction was later required in five hips, open reduction and innominate osteotomy in eight hips, and hip extracapsular innominate osteotomy in one hip. The results were evaluated according to the age groups with highest rate of complications after the age of 15 months. The treatment protocol was changed to limit conservative treatment until the age of 14 months. In cases without high dislocation, no traction as preparation for manipulation was used

modified innominata osteotomy in the treatment of severe acetabular dysplasias - 5 years' experience in Kuwait

A modified innominate osteotomy for the correction of severe acetabular dysplasia was used between 1992 and 1996 in 15 children for whom there were complete clinical and radiological data up to February 1998. The average age at the time of surgery was 32 months [range 17 to 50]. Congenital dislocation of the hip was bilateral in 8 cases, left-sided unilateral in 4 and right-sided unilateral in 3. The duration of post-surgery follow-up averaged 4 years [range 2 to 6]. Case evaluation for all patients was very good [McKay clinical and radiological classification]. Correction of the acetabulum index angle by this modified pelvic osteotomy was increased up to 40 degrees, as compared with 15 degrees, obtainable in the classical Salter innominate osteotomy

Local fibrocartilaginous dysplasia: an unusual cause of tibial vara

We report on one case with tibia vara caused by focal fibrocartilaginous dysplasia [FFD] of the medial aspect of the proximal tibia A Kuwaiti boy 4 1/2 years of age had developed a progressive deformity of the right proximal tibia between the age of 2 and 4 which on presentation had reached 35 degrees of varus deformity Because conservative management is recommended in the literature, and also because some reduction in the deformity was observed after the age of 4, surgery was postponed Indeed, the excellent response observed with conservative management makes recognition of this disease entity Important The condition is exceedingly rare with only 25 cases having been described in the world literature up to the present