One stage treatment of DDH in children older than two years with special reference to acetabular remodeling

We reviewed the results of twenty patients [twenty-five hips] who had operative treatment for correction of neglected developmental dislocation of the hip. We had special interest in the study of acetabular remodeling potential after open reduction and femoral osteotomy. Marked spontaneous correction of the acetabular index was observed in all but one hip and only one pelvic osteotomy was needed for full correction of this hip. The average follow-up was five years and three months [2-6 years]. At the end of follow up the acetabular index improved from an average of 34 degrees preoperatively [range 30 degrees to 40 degrees] to 18 degrees postoperatively [range 12 degrees to 22 degrees]

Surgical repair of neglected achilles tendon ruptures

Nine patients, average age 32 years, were treated with surgical repair for a neglected rupture of Achilles tendon. The mean time from acute injury to repair was 4.2 months. The method of repair included: excision of the interposed scar tissue, V in Y tendinous flap, end-to-end anastomosis, and augmentation in 6 patients with a free plantaris tendon graft and in 3 patient with a gastrocnemius aponeurotic flap. The gap length after trimming ranged from 4.5 to 6.5 cm. The follow-up period averaged 24 months, and the recovery time from repair to full activity ranged from 5.5 to 10 months, All patients were satisfied with the results, and all have been able to return to their preinjury activity level. No reruptures were encountered and few complications were recorded. MRI study was available in 6 patients for preoperative evaluation and for assessment of healing process. The overall results of this combined surgical technique are very encouraging; a strong, clinically functional Achilles tendon complex can be obtained. This technique is recommended for neglected rupture when end- to-end anastornosis is impossible due to extensive scar and retracted rupture ends