Prognostic Factors in Recurrent Congenital Muscular Torticollis

@#Introduction: Congenital muscular torticollis (CMT), primarily resulting from unilateral shortening and fibrosis of the sternocleidomastoid muscle. One of the common surgical complications is recurrent deformity. However, the associations between unipolar or bipolar release, age of the patient, and the recurrence of the disease are unclear. Therefore, the purpose of this study was to evaluate the factors associated with recurrence after surgery. Materials and Methods: A retrospective review was performed in 47 patients who were diagnosed with CMT and had been treated surgically with unipolar or bipolar release between January 2007 and December 2015. Demographic data (sex, sides, surgical technique, age at time of surgery, period of follow-up, complications and recurrence) were recorded. Results: Forty-seven patients with an average age of 8.7 years old at time of surgery. Twenty-six patients had rightsided muscular torticollis, while 21 had left-sided. The average follow-up time was 2 years (range, 2–4 years). The average age of unipolar release was 8.8 years old (range, 2- 18 years old), while the average age of bipolar release was 8.7 years old (range, 2–13 years old). Recurrence occurred in 11 patients (9 in unipolar and 2 in bipolar release). Sex, side of deformity, type of surgery and age at time of surgery showed no statistically significant as a factor for recurrence rate, however recurrence of unipolar more than bipolar surgery was nearly two times revealing clinical significance. Conclusions: Sex, side of deformity, type of surgery and age at time of surgery were not associated with the recurrence deformity.

Normal values and reliability in the radiological measurement of the hip joint in Thai children.

Normal values of radiological measurement of the hip joint in Thai children aged 0 -14 years old except for CE angle (5 –14 years old) were measured in normal children without hip problems such as hip dysplasia, fractures and dislocations, tumor, infection etc. with index of rotation of the pelvis between 0.56 -1.8. The right and left had equal values without statistical significant. The values of mean+ 2SD were 18.11o + 10.16o for acetabular index (233 cases), 25.16o 10.50o for CE angle (109 cases), 0.85+ 0.32 cm for head teardrop distance (201 cases), 90.70+ 21.86 % for head coverage (152 cases). The reliability test were performed. The means difference in absolute values for intraobserver and for interobserver were 2.22o and 2.11o for acetabular index, 3.24o and 2.86o for CE angle, 0.11 cm. And 0.08 cm. For head teardrop distance. The ICC were more than 0.69 except ones for interobserver of head teardrop distance (0.56), the reliability tests were good enough in this study. The mean acetabular index in 9 hips of CDH had statistically different (p=0.0000) compared with mean acetabular index in normal 36 hips, The acetabular index in normal hips more than 32o should be considered abnormal in Thai children.