Radiological Outcomes of Overhead Traction Therapy for Developmental Dysplasia of the Hip in Non-ambulatory Children.

BACKGROUND: Infants with a dislocated and unstable hip that does not lend itself to stabilisation may be treated using overhead traction to achieve gradual reduction of the hip joint. The aim of this paper was to analyse the radiological outcomes of overhead traction therapy and the effect of duration of traction on the occurrence of complications and final treatment outcomes. Material and methodd. A retrospective analysis of medical records of 26 children (34 affected hips) involved three independent observers assessing radiological parameters before the surgery and at follow-up visits at least two years after the therapy. RESULTS: Overhead traction was used for an average of 35 days (range: 15-43 days). Twenty six hips were treated solely with reduction and immobilisation in a 'human position' plaster cast. Three hips were qualified for surgery immediately after a preliminary traction period. Five hips showed a suboptimal result following the immobilisation period. A MANOVA model revealed that the following factors had a significant effect on the treatment outcome: superior centring ratio of Smith (with the lowest values recorded in patients with residual hip dysplasia, p = 0.001) and acetabular angle of Sharp (with the lowest values found in patients requiring surgery, p = 0.01). Statistical tests did not show a correlation between the duration of traction and disturbance of proximal femoral metaphysis growth assessed according to Bucholz and Ogden classification. Fifteen hips were classified as type I, eight hips were graded as type II and also eight hips as type III. CONCLUSIONS: The lowest values of acetabular angle of Sharp were recorded in patients requiring surgery and the lowest superior centring ratio of Smith was found in those with residual hip dysplasia. The duration of overhead traction did not directly correlate with the final outcome; it only seemed to be an indicator of the severity of hip dysplasia. Routine use of overhead traction before undertaking closed reduction does not probably decrease the incidence of proximal femoral growth disturbance.

Dislocation of the patella in a patient with Rubinstein-Taybi syndrome--a case study.

The Rubinstein-Taybi syndrome is a rare syndrome of congenital disorders whose etiology is still unknown. Most RTS patients have musculoskeletal abnormalities which, if untreated, may significantly affect independent mobility. This paper presents the results of a surgical treatment of a 13-year-old patient with RTS and instability of the patellofemoral joint. The patient was followed up for 3 years. Surgery resulted in complete pain relief, increased knee range of motion and marked improvement in the patient's gait. An extensive plasty of the extensor apparatus of the knee joint increases the likelihood of a good and lasting treatment result in patients with RTS and instability of the patellofemoral joint.

Habitual dislocation of the hip in neurofibromatosis type 1. Case study.

A 15-year-old boy with neurofibromatosis type 1 developed habitual dislocation of the right hip. No intraarticular pathology could be found in imaging studies. The dislocation became fixed during the follow-up.

[Results of surgical treatment of congenital clubfeet with the Sotirow method]. / Ocena wyników operacyjnego leczenia wrodzonej stopy konsko-szpotawej metoda Sotirowa.

Clinical and radiological results of surgical treatment of congenital clubfeet by an antero-lateral approach first introduced by Sotirow in 1976 are presented. The aim of this paper was to assess long-term results of this procedure on children (aged 5-18 months at the time of surgery). A series of 65 feet in 42 cases diagnosed with congenital talipes equinovarus was evaluated. Forty-two cases were treated conservatively with casts--changed on a weekly basis for 2-3 months and then every 2 weeks. Magone's score criteria were used to assess the method. Average follow-up was 7 years. Clinically 72% of the results were rated as excellent or good. We found the biggest problem during the Sotirow procedure was placing the trochlea of the talus bone into his anatomical into its' anatomical position in the talo-crural joint. The method introduced by Sotirow seems to be highly effective and worth applying. It enables a real elimination of soft-tissue contractures, which retains the deformity of the foot through an antero-lateral approach.