DDH Epidemiology Revisited: Do We Need New Strategies?

BACKGROUND: Although the developmental dysplasia of the hip (DDH) is well known to pediatric orthopedists, its etiology has still remained unknown and despite dedication of a vast majority of research, the results are still inadequate and confusing. The exact incidence of DDH and its relationship with known risk factors in Iran is still unknown. Here we represent the results of one year study on the incidence and related conditions of DDH. METHODS: Sonography was performed on the hip joints of 1073 full term healthy newborns at Imam Khomeini Hospital from March 2013 to March 2014. The results were classified according to Graf's classification. Pathologic hips were cross checked by the known risk factors for DDH. RESULTS: A significant correlation was found between DDH and breech presentation (P=0.000), torticollis (P=0.004), metatarsus adductus (P=0.024). CONCLUSION: The incidence of DDH is significantly high in the studied group of neonates, suggesting reevaluation of current approach to DDH. The screening protocols need to be improved with the help of trained pediatricians and other health professions.

Contribution of surgery in solitary plasmacytoma of spine; a case report.

Solitary plasmacytoma of bone is a rare malignant tumor mostly involving the axial skeleton. The tumor occurs in middle- aged or elderly people (mean age: 55 years) and has a high risk of progression to multiple myeloma. Radiotherapy is the preferred treatment for this disease. We report a case of recurrent solitary plasmacytoma of the fourth lumbar vertebra in a 35-year-old male. The patient suffered from intractable pain due to a pathologic fracture and instability. We performed two-stage posterior and anterior surgical procedures on him. Our method was useful for immediate pain relief and early return to activity, spinal decompression and biomechanical stabilization of the involved vertebra. Afterward, the patient underwent radiotherapy as the adjuvant therapy. The patient is asymptomatic without any recurrence after a one-year follow up. We recommend surgery as an appropriate option for patients with intractable pain as a result of pathologic fracture, vertebral instability, neurological compromise, failure of radiotherapy or a combination of these disorders.