ABSTRACT
In September 2018, an international meeting of doctors of various disciplines, with expertise in the detection and treatment of DDH, was held in Csolyospalos, Hungary. The aim was to achieve consensus on the detection and early treatment of the condition and to develop a standardized system of teaching and training for hip ultrasound. There was strong agreement that US screening is essential. Specifically the Graf technique was selected as the technique of choice. Universal US screening was strongly favored. Screening should be carried out as soon as possible, but not later than the sixth week of age. US screening is cost-effective, does not result in overtreatment, and contributes to a reduction of long-term consequences. The essential principle of treatment is timely application of a device to achieve reduction, retention and maturation, by holding the hips in flexion, and a safe degree of abduction. It was agreed that the effectiveness of any screening policy depends on the correct scanning technique. Therefore, standardization of teaching and training of the Graf technique is mandatory. A unified teaching policy and materials should be developed for this purpose. Certification, re-certification and audit were discussed. The group, which has been formalized as the International Interdisciplinary Consensus Committee On DDH Evaluation (ICODE), will continue to meet and work towards establishing international consensus on DDH, standardizing and developing teaching and training of the Graf technique for hip US, and maintaining standards for detection and management.
Subject(s)
Hip Dislocation, Congenital , Ultrasonography , Consensus , Hip Dislocation, Congenital/diagnostic imaging , Humans , Hungary , Infant, Newborn , Neonatal ScreeningABSTRACT
BACKGROUND: Isolated avulsion fractures of the greater and lesser trochanter are usually seen in adolescents prior to the fusion of the apophysis. Greater trochanter fractures in adults have a high incidence of intertrochanteric extension and lesser trochanter fractures are regarded as a pathognomonic sign of metastatic disease. These fractures are very rare among children. METHODS: We report five cases of trochanteric fractures in children of less than two years of age three of which were unrecognized initially in the accident and emergency department. RESULTS: Early and complete recovery ensued following immobilization and symptomatic treatment. Surgical intervention was not required. CONCLUSIONS: There needs to be a high index of suspicion to diagnose these fractures in children and plain radiographs need to be carefully examined when assessing a limping child. Our experience shows when correctly diagnosed these injuries can be treated successfully with supportive treatment and no need for surgical intervention. LEVEL OF EVIDENCE: IV Case series.
Subject(s)
Hip Fractures/diagnostic imaging , Hip Fractures/therapy , Accidental Falls , Conservative Treatment , Female , Hip Fractures/etiology , Humans , Infant , Infant, Newborn , MaleABSTRACT
OBJECTIVES: To devise a new protocol for targeted CTscanning of the distal tibiofibular syndesmosis with minimal radiation exposure to patients. We also aimed to correlate the reduction of the syndesmosis as seen on CT scans with the functional outcome of patients. MATERIALS AND METHODS: Prospective study. Forty adults undergoing surgical stabilisation of an acute distal tibiofibular syndesmosis injury were recruited. A targeted five-cut computerised tomography scan protocol was developed. The radiation exposure to the patient with this protocol was only 0.002 mSv. Scans were performed 12 weeks after surgery. The contralateral ankle of every patient was used as a control to determine the accuracy of the reduction of the syndesmosis for that individual patient. American Orthopaedic Foot and Ankle Society (AOFAS) scores were obtained at a minimum of 1 year after surgery. RESULTS: After considering the exclusions, 36 patients formed the study group. A wide variation was observed in the anatomy of the normal syndesmosis. If we considered a difference of more than 2 mm between the normal and injured syndesmosis relationship as significant, 15 (41.6 %) of our patients had a significant difference between the injured and normal sides. AOFAS scores were available for 13 of these patients and were good to excellent in 11(84.6 %). CONCLUSION: Our study describes a reliable new CT scanning technique for the distal tibiofibular syndesmosis using only five cuts and a low-radiation-dose protocol. Clinical correlation of the findings on the scan with functional outcomes suggests that routine post-operative CT of the syndesmosis is probably not justified.
Subject(s)
Ankle Fractures/diagnostic imaging , Ankle Fractures/surgery , Ankle Joint/diagnostic imaging , Arthrography/methods , Radiation Exposure/prevention & control , Tomography, X-Ray Computed/methods , Adult , Aged , Female , Fracture Fixation, Internal/methods , Humans , Male , Middle Aged , Radiation Dosage , Radiation Exposure/analysis , Radiation Protection/methods , Radiographic Image Enhancement/methods , Radiographic Image Interpretation, Computer-Assisted/methods , Reproducibility of Results , Sensitivity and Specificity , Treatment OutcomeABSTRACT
Tension band technique has been described as a successful method of treatment for the fractures of the proximal part of the fifth metatarsal bone. A high rate of union and a low rate of complications have made this mode of treatment popular, especially in patients with nonunion and high-level athletes with stress fracture of the proximal fifth metatarsal bone. The authors report a case of an avulsion fracture of the base of the fifth metatarsal bone treated with tension band wiring fixation, which resulted in a stress fracture 1 year after the tension band wiring. The authors recommend a K-wire perforation and tension band drill hole distal to the watershed area of the fifth metatarsal bone and removal of metalwork 6 to 12 months after fracture union to avoid this complication.
