Evaluation of surgical treatment of developmental dysplasia of hip for avascular necrosis of femoral head in children.

Developmental Dysplasia of the Hip (DDH) is a common congenital malformation. Avascular necrosis of femoral head is the major complication of both close and open reduction of the dislocated joint. Aim of this study was to determine the incidence and influencing factors in different types of a vascular necrosis of femoral head, following surgical treatment of developmental dysplasia of hip in 1-7 years patients. In this study, 120 patients aged from 1 to 7 years old with DDH who had been undergone open surgery, entered to the study. All of these patients followed up for at least 1 year. Surgery procedures divided to 4 groups: open reduction, open reduction+salter osteotomy, open reduction+femur shortening and open reduction+salter osteotomy+femur shortening. The presence of Avascular Necrosis (AVN) had been appraised. 27.5% of surgeries performed on male and 72.5 on female patients. 35.0% of DDH cases were unilateral and remaining was bilateral. 36 patients (30%) shows radiologic findings of AVN, although all of them placed at group I of Bucholz-Ogden classification. 40% of group A patients, 25% of group B, 14.3% of group C and 36.4% of group D patients developed this findings. Open reduction of DDH in older children is effective in the management of DDH and if all of the contrivance considered in the surgery, the rate of AVN would be low and mild (at least in short term follow ups).

Scoliosis curve: before and after surgical correction.

The main purpose of this study was to report the surgical experiences and to evaluate the effectiveness of Two-stage operation (including 1-anterior release and fusion with hylofemoral traction and 2-posterior correction and fusion) in scoliosis. The prospective study was performed on 45 scoliotic patients presenting to Tabriz Shohada Orthopedics Teaching Referral Hospital between January 2002 and July 2007. Two-stage operation (anterior release and fusion with hylofemoral traction followed by posterior correction and fusion) was performed for cases in which the scoliosis angle was > 70 degrees and the correction level on bending films was less than 50%. Forty five patients, 32 (71.1%) female and 13 (28.9%) male, with mean age of 15.13 +/- 0.34 years (range of 10 to 18 years), were studied. According to the consecutive sampling, the relation of scoliosis with patients sex was significant (p < 0.005). The mean scoliosis angle was 73.31 +/- 4.21 before operation and 36.11 +/- 2.56 after operation (p < 0.005). The mean preoperative kyphosis angle was 29.95 +/- 3.9 and the mean postoperative kyphosis angle was 24.6 +/- 2.2 (p < 0.005). Scoliosis was significantly more severe in males than females.