Predictors of Hip Dysplasia at 4 Years in Children with Perinatal Risk Factors.

While perinatal risk factors are widely used to help identify those at risk for developmental dysplasia of the hip (DDH) within the first 6 to 8 weeks of life, limited data exist about their association with radiographic evidence of dysplasia in childhood. The purpose of this study was to determine which perinatal risk factors are associated with acetabular dysplasia in children who are ≥2 years of age. METHODS: Pelvic radiographs were made in 1,053 children (mean age, 4.4 years [range, 2 to 7 years]) who had been assessed prospectively as having at least 1 of 9 widely accepted perinatal risk factors for DDH. Two radiologists who were blinded to patient risk factors, history, and age determined the acetabular index (AI). The primary outcome was defined as an AI >2 standard deviations from the Tönnis reference values ("severe" dysplasia). The secondary outcome was an AI of >20° at >2 years of age. The association between risk factors and outcomes was assessed using logistic regression. The effect of treatment in infancy was adjusted for in 37 hips. RESULTS: Twenty-seven participants (3%) showed "severe" hip dysplasia; 3 of these had received treatment for DDH in infancy. Girls were more likely to experience this outcome (odds ratio [OR] = 2.59; 95% confidence interval [CI] = 1.04 to 6.46; p = 0.04); no other examined risk factors were significant. The secondary outcome appeared in 146 participants (14%), 12 of whom had received treatment in infancy. We observed the following predictors for this outcome: female sex (OR = 1.77; 95% CI = 1.21 to 2.59; p = 0.003), breech presentation (OR = 1.74; 95% CI = 1.08 to 2.79; p = 0.02), and being a firstborn child, which had a protective effect (OR = 0.67; 95% CI = 0.46 to 0.96; p = 0.03). CONCLUSIONS: We identified a substantial number of cases that will require at least radiographic surveillance for mild and severe hip dysplasia; 92% had no prior diagnosis of DDH. Those who had been born breech were affected by this outcome even if ultrasonography of the hip had been normal at 6 to 8 weeks, suggesting a benefit from additional radiographic testing. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Enhanced recovery programme for total knee replacement to reduce the length of hospital stay.

PURPOSE: To compare the length of hospital stay in patients undergoing primary total knee replacement (TKR) with or without enhanced recovery (ER) programme. METHODS: Medical records of 57 and 55 consecutive patients who underwent primary TKR with or without ER programme, respectively, were reviewed. 17 men and 40 women aged 43 to 87 (mean, 70) years with ER programme were compared with 22 men and 33 women aged 53 to 90 (mean, 73) years without ER programme in terms of the preoperative haemoglobin level, American Association of Anesthesiologists (ASA) physical status grading, body mass index (BMI), and length of hospital stay. RESULTS: The length of hospital stay was significantly shorter in the ER than non-ER groups in overall patients (6 vs. 7.8 days, p=0.0003), in patients with preoperative haemoglobin level of ≥ 14 g/dl (5.4 vs. 7.7 days, p=0.02), in patients with preoperative haemoglobin level of <14 g/dl (6.2 vs. 7.7 days, p=0.02), in patients with ASA grades 1 and 2 (5.6 vs. 7.6 days, p=0.01), in patients with ASA grade 3 (6.4 vs. 8.2 days, p=0.01), in patients with BMI of <30 kg/m(2) (6 vs. 8.1 days, p=0.0061), and in patients with BMI of ≥ 30 kg/m(2) (5.9 vs. 7.5 days, p=0.0006). Complications were noted in 4 ER patients and 5 non-ER patients. CONCLUSION: ER programmes are readily transferable to patients undergoing TKR and significantly reduced the length of hospital stay.

Erect radiographs to assess clinical instability in patients with blunt cervical spine trauma.

BACKGROUND: Computed tomography (CT) and magnetic resonance imaging (MRI) are sensitive modalities for the assessment of the spine, but certain injuries remain poorly assessed with supine radiographs. We describe four cases in which cervical spine injuries were proven as unstable with erect radiographs after being previously evaluated with supine radiographs and CT scans. METHODS: A retrospective review of medical records and images was used to identify four patients who presented to a teaching hospital from April to December 2010 with unstable cervical spine injuries that were only demonstrated on erect radiographs. RESULTS: All four patients sustained either C4-C5 or C5-C6 injuries. Prior to diagnosis, each had been evaluated with supine radiographs that did not demonstrate instability. Computed tomography identified the osseous injuries that were present but did not provide suitable assessment of stability. Three patients successfully underwent anterior cervical discectomy and fusion. The fourth was managed with a Halo jacket because of major comorbidities. CONCLUSIONS: Despite major advances in imaging, these cases highlight the importance of physiological loading and radiographs. The controlled use of erect radiographs to test for clinical instability in patients with cervical spine injuries should be considered except in cases in which instability is already evident on other imaging modalities and/or surgical treatment is already indicated.

Syntheses, structures and magnetic properties of Mn(II) dimers [CpMn(micro-X)]2(Cp = C5H5; X = RNH, R1R2N, C[triple bond]CR).

Manganocene, Cp(2)Mn, has been employed as a precursor in the synthesis of a range of Mn(II) dimers of the type [CpMn(micro-X)](2)[X = 8-NHC(9)H(6)N (1), N(Ph)(C(5)H(4)N)(2), N(4-EtC(6)H(4))(C(5)H(4)N)(3) and C[triple bond]CPh (4)] as well as the bis-adduct [Cp(2)Mn[HN=C(NMe(2))(2)](2)](5). The solid-state structures of 1-5 are reported. Variable-temperature magnetic measurements have been used to assess the extent of Mn(micro-X)Mn communication within the dimers of 1-4 as a function of the bridging ligands (X).