RESUMO
Objective: To evaluate the efficacy of using a Pavlik harness Orthosis in reducing dislocated hips in patients with developmental dislocation of the hip
Methods: This is a prospective study done on patients who visited the pediatric orthopedics clinic in the Royal Medical Services in the period between October 2010 and June 2015. Each patient diagnosed by radiography and fulfilled the inclusion criteria was examined prior to the application of a dynamic flexion abduction orthosis [Pavlik Harness orthosis] and then the Orthosis application is checked by one of the authors whom are a senior consultant pediatric orthopedic surgeon and four pediatric orthopedic specialists. After that, a follow up period of two weeks is given to those patients who present with a dislocated hip in the age between three to six months. The patients were reevaluated after two weeks by clinical examination of both hips and by radiography while maintaining the Pavlik harness orthosis applied on the patient
Results: In this study 133 patients had fulfilled the inclusion criteria. The number of dislocated hips was 184. We found that there were 82 patients 61.6% who presented with unilateral hip dislocation and 51 patients 38.4% who presented with bilateral hip dislocation. Female:Male ratio of 6.4:1 . 128 hips 69.7% achieved reduction after the application of a pavlik harness orthosis at two weeks follow up. And 56 hips 30.3% diagnosed as a case of failed hip reduction and underwent closed reduction under general anesthesia with or without Adductor tendon tenotomy and static hip spica cast application. 3 patients 2.2% developed femoral Nerve palsy that fully recovered after discontinuity of Orthosis application
Conclusion: The use of Pavlik Harness Orthosis is an effective method of treating patients who present with a dislocated of hip in the age between three to six months. The younger the patient the better the outcome
RESUMO
To evaluate the shoulder functional outcome in children with obstetrical brachial plexus palsy after performing latissimus dorsi muscle transfer and subscapularis muscle release. This is a retrospective analysis to fifty patients with 52 shoulders underwent latissimus dorsi muscle transfer and subscapularis muscle release for obstetrical brachial plexus palsy, between June 2008 and April 2012. Reviewing patient's files and pre-operative videos. Mallet scoring system was used to evaluate the shoulder functional changes. Fifty children with fifty two shoulders with a ranging age between 18 months up to 13 years were involved in this study, 1:1 male to female ratio, the average birth weight was 3.89KG, the brachial plexus extent of injury were ranging from upper injury 80% to total palsy 20%. Regarding the affected limb the right side involvement was 60% the left side 36% and bilateral involvement was 4%.there is significant difference in the global upper limb function between younger age group[below five years] when compare to older age group[above five years of age]. Five active ranges of motion around the shoulder joint involved in the injury were analyzed with the following functional outcome improvement: Global Abduction 46.6%, Global External Rotation 62.9%, Hand to neck 49%, Hand to spine 53.3%, Hand to mouth 57.2%. We found that this type of surgery improves the global function of the upper limb in patients with obstetrical brachial plexus palsy, this improvement become less remarkable in older children[>5years of age]. And the majority of patients and their families were satisfied by the achieved results