Hip joint development in children with type IIb developmental dysplasia.

PURPOSE: The aim of this study was to analyse the results of treatment of sonographically diagnosed type IIb developmental hip dysplasia and to identify residual hip dysplasia using clinical and radiological assessment. METHODS: We retrospectively reviewed the data of 49 children (59 type IIb and 39 type I hips, according to Graf's monographic classification) treated in abduction braces. The mean age was 9.1 years (range 4-15) at latest follow-up. RESULTS: According to the clinical classification of Mckay in Barrett's modification, all the type I and type IIb hips had very good results. No statistical differences were found between type I and IIb hips when comparing both measured radiological parameters and radiological results according to the Severin classification at latest follow-up. Using our criteria (two or more radiological parameters were outside of their normal range), 12 out of 49 type IIb hips demonstrated persistent dysplasia. Of the 12 hips, eight sonograms were normal at the end of treatment and four patients failed to normalise. No type I hips demonstrated two or more abnormal radiographic parameters at latest follow-up. CONCLUSIONS: Despite obtaining normal sonograms at the end of treatment, some children with type IIb dysplasia may demonstrate radiographic evidence of persistent hip dysplasia over a longer follow-up period. Our results suggest that these children should be monitored until skeletal maturity.

[The assessment of changes in radiological parameters of acetabulum of the hip joint according to position of the pelvis]. / Ocena zmian wartosci parametrów radiologicznych panewki stawu biodrowego w zaleznosci od ustawienia miednicy.

The aim of the study was to analyze the repeatability of selected radiological parameters in the assessment of mild forms of developmental dysplasia of the hip and to evaluate the changes of the parameters according the position of the pelvis. Retrospective review of radiographs of 98 hips (49 children) was done in antero-posterior and Lauenstein position. Among them 59 hips were treated for type II hip dysplasia according to Graf. At the latest follow-upthe mean age was 9.1 years (range from 4 to 15 years). On radiographs in antero-posterior position of the hips mean rotation index (Tönnis-Brunken index) was 1.0, and on radiographs in Lange position was 0.98 and had no influence on measured parameters. On radiographs in antero-posterior position pelvis was more in forward rotation than in Lange position. With the pelvis in more forward rotation (measured using Ball-Kommend index) the value of Lequesne and Ullmanna-Sharp angles were decreased and Wiberg angle was increased. The angles had good repeatability. The other parameters: acetabular index, decentration distance and Idelberg-Frank angle were not statistically related to Ball-Kommend index. Idelberg-Frank angle had satisfactory repeatability but acetabular index and decentration distance had poor repeatability. Considering above mentioned characteristics of Idelberg-Frank angle, this parameter may be a useful tool for assessment of the hip.

[Upper limb function in children with obstetric brachial plexus palsy]. / Funkcja konczyny górnej u dzieci z przetrwalym okoloporodowym porazeniem splotu ramiennego.

BACKGROUND: The purpose of the study was to analyze shoulder, elbow and forearm function in children with persistent obstetric brachial plexus palsy. We aimed also to evaluate relationship between age, severity of root involvement and functional deficit of affected limb. MATERIALS AND METHODS: Fifty-one patients with the Mallet score less than 23 points were entered into a prospective study. Their average age was 6 years and 6 months (range from 18 months to 19 years). There were 30 boys and 21 girls. Clinical data from last follow-up was evaluated. RESULTS: Average Mallet score was 17 points at last follow-up. The most common problem found in 60% of children was limitation of active external rotation of the shoulder. One forth of patients had posterior dislocation or subluxation in glenohumeraljoint. Moreover, 35.3% had significant limitation of active flexion, 37.3% had limitation of active abduction and 37.3% had limitation of internal rotation of shoulder. Limitation of active forearm pronation was found in 37% and active supination in 50% of patients. Persistent limb dysfunction (except shoulder external rotation) was dependent on root involvement but did not depend on patient's age. CONCLUSIONS: Limitation of shoulder external rotation with concomitant posterior subluxation or dislocation of the glenohumeral joint is the most common finding in patients with obstetric brachial plexus palsy and does not depend on severity of root involvement, as is related to suprascapular nerve injury. The other shoulder movement are more effected in children with more severe nerve root involvement. Half of our patients had had limitation of forearm supination, what may be related to more common use of pronation in everyday activities.

[The value of femoral anteversion angle measured clinically and on radiographs]. / Wartosc pomiaru kata przodoskrecenia blizszego konca kosci udowej wyznaczonego klinicznie i radiologicznie.

The purpose of the study was to analyze the value of clinical and radiological measurements of femoral anteversion. There were 49 patients (39 girls, 10 boys) with the mean age of 9.1 years (range from 4 to 15 years) at last follow-up. Among 98 analyzed hips 59 had IIb hip dysplasia according to Graf at childhood. Clinically femoral anteversion angle was measured using the trochanteric prominence angle test. On radiographs femoral anteversion angle was measured according to Strzyzewski method. Femoral anteversion wasn't significantly increased in joints type IIb. The correlation of clinical and radiographic determination of femoral anteversion was good (r=71) and it is recommended for routine examination. Hip rotation in flexion (r=59) better correlated with radiographic anteversion than in extension (r=46) and their combination increased correlation (r=62). Clinical examination in hips flexed 90 degrees allows for better assessment of femoral anteversion than examination done in hip extension.

[Elective total hip arthroplasty for patients 75 years of age and older]. / Alloplastyka calkowita stawu biodrowego w leczeniu choroby zwyrodnieniowej u osób po 75. roku zycia.

The increasing life expectancies among octogerians ang nanogerians cause increased need for total hip replacement in this age group. The aim of our study was to analyze final results after total hip arthroplasty in patients 75 years of age and older. Clinical and radiological retrospective study was performed on a group of 59 patients (72 hips) in the mean age of 78 years. Minimal follow-up was 3 years. According to Harris Hip Score hip function improved on an average of 47 points and at final follow-up was 86 points. Patients with medical diseases had poorer hip function improvement. Early dislocation was found in 3 patients with was treated conservatively with good result. Almost 1/4 of patients suffered medical postoperative complications: pneumonia (n = 1), urinary tract infection (n = 4), pulmonary embolism (n = 1), acute myocardial infarction (n = 1), postoperative confusion (n = 5) and mild intestinal occlusion (n = 1). Additionally, one patient died for pulmonary embolism. There were no radiological signs of aseptic loosening or need for revision operation. Three fourth of our patients had satisfactory results after total hip replacement, despite relatively high medical (24%) and local complication rate. Aseptic loosening is rear in this age group.

[Treatment of physeal fractures in children]. / Leczenie zlaman kosci dlugich z jednoczesnym uszkodzeniem chrzastki wzrostowej u dzieci.

The aim of the study was to determine final clinical and radiological results of epiphyseal fractures treated in our hospital. Thirty-five patients were included in the study (6 girls and 29 boys) aged from 5 to 17 years (mean 12.1 years). Follow up ranged from 2 to 20 years. According to Salter and Harris classification system 15 patients had type I and 20 had type II fracture. According to the Neer-Horowitz classification system of the proximal end of humerus one patient had grade III and three had grade IV fracture. Physeal fractures included: proximal end of humerus (n = 4), distal end of radius (n = 16) (with coexistent distal end of ulna fractures in 6 cases), distal end of femur (n = 4), distal end of tibia (n = 3) and distal end fibula (n = 8). Six patients were treated with open reduction and K-wire fixation, three with skeletal traction and cast, one with closed reduction and K-wire fixation and twenty five with closed reduction and cast. Neurovascular deficit was noted in any of our patients at admission and after reduction. During follow-up we did not notice physeal arrest, changes in limbs axis or limb shortening in any of our patients. All our patients had good clinical results. In 2 cases in early postoperative follow-up limitation of shoulder abduction after physeal fracture of proximal humerus was observed. Restoration of proper anatomical conditions is conducive to restore function of growth plate. Kirschner wire fixation did not increase the risk of growth arrest. Physeal injuries at the end of growth did not cause limb axis changes.

[Calcaneal solitary bone cysts in children]. / Torbiel samotna kosci pietowej u dzieci.

The purpose of our study was to analyze the final results of the treatment of calcanear solitary bone cyst in children and standardize management on the basis our material. We assessed retrospectively the case notes, radiographs and pathologic reports of six patients (seven solitary calcanear bone cyst) in the average age of 16.6 years. The mean follow-up was 3.8 years, minimum 2 years. Curettage and bone grafting yielded uniformly healing and regression of symptoms in 5 children. Multiple drilling (1 patient) and steroid acetate injection failed to show cyst healing. One bone cyst remained asymptomatic during follow-up. Our experience shows that, only large bone cysts and those causing pain should be treated surgically.

[Patients' assessment of obesity treatment with Roux-en-Y gastric bypass surgery]. / Wyniki operacyjnego leczenia otylosci metoda gastric by-pass w ocenie chorych.

UNLABELLED: Morbid obesity defined as BMI > or = 40 kg/m2 is associated with serious co-morbidities e.g. hypertension, type 2 diabetes mellitus, cardiovascular disease, respiratory insufficiency, sleep apnea syndrome, estrogen-dependent tumors, and degenerative arthritis. Moreover, general results of lifestyle intervention and/or drug therapy in these patients are less than satisfactory. It is widely believed that obesity surgery including gastric by-pass has proved to be an effective method of achieving maintained body weight reduction. The aim of this study was to investigate change in body weight, prevalence of co-morbidities, and quality of life after Roux-en-Y gastric by-pass surgery. 56 patients who underwent Roux-en-Y gastric bypass in 1999-2001 were asked to answer a 42-question-questionnaire. RESULTS: Complete answers were received from 36 subjects (mean (+/- SD) age 39 +/- 10 years, body weight 127.5 +/- 20.4 kg, BMI 4.40 +/- 5.6 kg/m2). Mean post-surgery follow-up time was 24 months. All patients reported significant weight loss (35.8 +/- 10.7 kg). A statistically significant decrease in prevalence of hypertension and various symptoms associated with cardiovascular disease, respiratory insufficiency, sleep apnea syndrome were noted as well as a significant improvement in quality of life. CONCLUSIONS: In morbidly obese patients Roux-en-Y gastric bypass is an effective and long-term well tolerated method of achieving stable weight reduction, leading to improvement in co-morbidities and quality of life.