The incidence of late-detected developmental dysplasia of the hip and its functional outcomes: a 17-year cohort study using selective ultrasound screening.

BACKGROUND AND PURPOSE: We aimed to establish the incidence of late-detected developmental dysplasia of the hip (DDH) with a selective ultrasound (US) examination over 17 years using the femoral head coverage (FHC) as a US measurement. The secondary aim was to establish the everyday function using patient-reported outcome measures (PROMs). PATIENTS AND METHODS: The incidence of late-detected DDH was based on 60,844 children. Patients diagnosed for the first time after 3 months and before the age of 8 years were included. In the second part of the study, consent to participate was mandatory. PROMIS-25 Pediatric, PROMIS-25 Parent, and EQ-5D-5L were used according to the patient's age to assess everyday function. RESULTS: The incidence of late-detected DDH was 0.48/1,000. The median age at diagnosis was 8 months (range 4-41 months), with a tendency to require repeated treatment with open surgery if DDH was diagnosed later. Most children reported no or minor health problems with a mean of 18 years' follow-up. CONCLUSION: We found that selective US examination of the hips by measuring the FHC is a reliable method to examine newborns for DDH resulting in a low incidence of late-detected DDH amounting to 0.48/1,000 newborn children.

Children treated for developmental dysplasia of the hip at birth and with normal acetabular index at 1 year: How many had residual dysplasia at 5 years?

Purpose: The purpose of the study was to assess the effect of further follow-up for children treated for developmental dysplasia of the hip, with normal clinical and radiological findings at 1-year time point. The effect was quantified by the number of hips with a pathologic deterioration up to 5 years. Methods: Among 47,289 children born in Sør-Trøndelag county in Norway between 2003 and 2015, 265 children had developmental dysplasia of the hip. Of these, 164 children (239 hips) treated for developmental dysplasia of the hip with normal clinical findings and normal acetabular index at the 1-year time point were included in the study. The number of hips with pathologic acetabular index at the 5-year time point were reported. The diagnostic uncertainty related to radiological measurements was quantified together with the effect of introducing a second radiographic measurement, the center edge angle. Results: A total of 239 treated hips were normal at the 1-year time point. At 5-year time point, 10 (4.2%) hips had a pathologic acetabular index measurement and none classified to have developmental dysplasia of the hip caused by measurement inaccuracy. Eight (3.3%) hips had pathologic center edge angle measurement. Four hips had both pathologic acetabular index and center edge angle measurements, with three later treated with surgery. The intra- and interobserver repeatability coefficients were within 3.1°-6.6°. Conclusion: The repeatability coefficient of the acetabular index measurements was high and no hips could be classified to have developmental dysplasia of the hip at the 5-year time point when taking this repeatability into account. Hips classified as pathologic combining acetabular index and center edge angle measurements were likely to be treated with surgery for residual dysplasia. We recommend further follow-up for these children. Level of evidence: level II.

Surgery for wrist Ganglia: one-hundred and twenty-two patients reviewed 8 years after operation.

Wrist ganglia give few symptoms, but are a common reason for referral to a hand surgeon. We studied patient long-term satisfaction after operation. We reviewed 122 patients, who were operated for dorsal (n=82) and volar (n=40) wrist ganglia 8 years before (range 3-11). Three radial arteries were injured during surgery for volar a ganglion. By the time of review 33 patients (27%) had a recurrence or had been re-operated. Radical surgery did not reduce the recurrence rate significantly. Reported general complaints from the wrist improved from a mean visual analogue scores (VAS, 0=best; 100= worst) of 56 before surgery to VAS 14 at review and unsightliness from VAS 50 to VAS 14. Patients were equally happy with transverse and longitudinal scars. Ten patients (8%) stated that they would not have consented to surgery if they had known the outcome in advance. We conclude that, in spite of a high recurrence rate, most patients are happy with the results of surgery.

Surgery for ganglia of the flexor tendon sheath.

There are very few reports in the literature on the results of surgery for ganglia of the flexor tendon sheaths of the digits. We reviewed 24 patients operated for flexor tendon sheath ganglia 8 (3-11) years previously. Two operations were for recurrences and one of these recurred again. There was one permanent digital nerve injury and one patient complained of cold sensibility. VAS (0=best; 100=worst) for mean general complaints from the hand was remembered as 51 before surgery and was 5 at review. Mean pain at review was reported as VAS 4 and general satisfaction with the operation as VAS 3. All stated that they would have consented to surgery if they had known the outcome in advance. We conclude that the results of surgery are good, although complications do occur.