Open reduction through a medial approach for congenital dislocation of the hip. A critical review of the Ludloff approach in sixty-six hips.

We reviewed the results of open reduction through the medial approach of Ludloff, done for congenital dislocation in sixty-six hips (sixty-three children). The mean age at the time of the operation was twelve months (range, two to sixty-three months), and the mean duration of follow-up was six years (range, two to thirteen years). Avascular necrosis was evident preoperatively in two hips (3 per cent) and was noted postoperatively in another seven hips (11 per cent). There was a correlation between the age of the patient at the time of the operation and postoperative avascular necrosis, with an increased prevalence of the complication in patients who had been managed with the open reduction after the age of twenty-four months. One redislocation and two subluxations were noted at the time of the first changing of the cast, four weeks postoperatively. Although the acetabular index decreased from a mean of 38 degrees preoperatively to a mean of 16 degrees at the time of follow-up, acetabular dysplasia did not resolve in 33 per cent of the hips and pelvic osteotomy was performed. We consider the Ludloff approach to be a safe and effective method for the treatment of congenital dislocation of the hip in infants who are less than the age of twenty-four months and in whom a concentric reduction with less than 60 degrees of abduction was not achieved following closed reduction. The advantages of this approach include direct access to the iliopsoas, the transverse acetabular ligament, and the constricted capsule; minimum loss of blood; and a cosmetically acceptable scar.

Randomized response estimates of problem use of alcohol among employed females.

As part of the evaluation of an alcoholism orientation program conducted in 12 federal agencies, 378 female employees were asked to provide personal information about problems associated with their use of alcohol. The optimized form of the unrelated question randomized response technique (RRT) was used to provide for a comparison of estimates of frequency of problem drinking obtained with guaranteed confidentiality of response versus estimates obtained using a conventional anonymous questionnaire. The estimated proportion of alcoholics or possible alcoholics among participants in the orientation program was 34.3% (+/- 4.9) by the RRT and 21.9% (+/- 3.6) by direct response. Significant underreporting of alcoholism was found among older respondents (greater than or equal to 36 years), lower GS level respondents (less than grade 6), those with low seniority (less than 8 years), and those never married. Further, significant underreporting was found among those who claimed they were told they had to attend the program versus others, and among those who claimed they were not curious about the topic of alcoholism versus others. The RRT is recommended for use in experimental situations where answers to sensitive questions are needed to evaluate program success. The necessity for caution in interpretation of apparent differences in respondent characteristics with respect to problems with alcohol use is discussed. Finally, the findings indicate the importance of providing avenues by which confidential treatment for alcoholism can be obtained.