Risk factors for additional surgery after closed reduction of hip developmental dislocation.

PURPOSE: to evaluate the risk factors for additional surgery after closed reduction of hip developmental dislocation Methods : closed reduction for developmental hip dislocation was performed on 72 patients, with a total of 82 hips (10 bilateral). Were included only patients with irreducible hip dislocation who were treated by overhead traction followed by closed reduction under general anaesthesia and spica casting. The mean age at the time of closed reduction was 10 months, with 82% of dislocation diagnosed after the age of 6 months. In 28 hips (34.1%), no additional surgical procedure was necessary, while 54 hips (65.9%) needed an additional surgery, consisting in Salter osteotomy in 40 hips (48.8%) or open hip reduction in 14 (17.1%). RESULTS: risk factors for the need of additional surgery were: older age at the time of reduction, male sex, high grade of hip dislocation (Tönnis grade 3 and 4, versus grade 1 and 2), and quality of hip reduction. All the patients older than 17 months at the time of closed reduction needed additional surgery. Bilateral hip dislocation had poorer Severin grading than unilateral dislocation. Poorer Kalamchi scoring was associated with older age and with the presence of the cephalic nucleus at the time of reduction. CONCLUSION: this study confirmed delayed diagnosis of hip dislocation leads to a more extensive treatment with poorer issue.

Orthodontic loading of titanium miniplates in dogs: microradiographic and histological evaluation.

OBJECTIVES: The objectives of this animal study were to evaluate if orthodontic loading has an impact on osseointegration of screws supporting miniplates, and to describe the histological components of the bone-screw interface. MATERIALS AND METHODS: Eighty orthodontic miniplates were placed in the jaws of 10 dogs. After 2 weeks, a 125 g force was applied between the miniplates of one upper quadrant of each dog and between those of the controlateral lower quadrant. The others, nonloaded miniplates, were considered as controls. Five dogs were sacrificed 7 weeks after implantation and the remaining five dogs after 29 weeks [Short Term (ST) and Long Term (LT) groups, respectively]. Fluorochromes were injected at implantation and at sacrifice. Jaw quadrants were dissected, embedded, cut into undecalcified transverse sections through the screws and finally submitted to microradiographic analysis to allow assessment of bone-implant contact (BIC) and bone volume/total volume (BV/TV). The sections were observed under UV light and stained in order to examine them under ordinary light. RESULTS: Osseointegration occurred around 90/160 screws and consisted mainly in limited repair and remodelling processes of lamellar bone, without inflammation. Wide variations were observed in BIC and BV/TV, but without any significant difference, neither between the loaded and the nonloaded screws, nor according to the direction of load, whereas they were significantly higher in the LT than in the ST group. Nonosseointegrated screws were surrounded by fibrous tissue. Osteoblastic activity, when present in front of these screws, was not sufficient to achieve stability. CONCLUSIONS: Osseointegration underlying orthodontic anchorage was not affected by loading. BIC increased with time and varied according to implantation site. Particularly the tight-fitting screw insertion appeared crucial in determining the appropriate bone healing response.