Faculty Bibliography

Early diagnosis is of paramount importance to favorably alter the natural history of DDH. Most cases of dysplasia can be diagnosed by careful history taking and physical examination. Imaging modalities, such as ultrasonography, have increased our ability to detect subtleties not appreciated by means of physical examination or plain radiography. Although the evaluation of children with risk factors for DDH is important, most dysplasia occurs in girls who have no other risk factors. For all infants, a competent newborn physical examination using the Ortolani maneuver is the most useful procedure to detect hip instability. Early treatment of an unstable hip with a Pavlik harness or similarly effective orthosis is effective, safe, and strongly advised.

BACKGROUND: We sought to determine the functional outcome of patients with grade 3 slipped capital femoral epiphysis who had been treated with in situ pinning at a mid-term follow-up. METHODS: One hundred and five patients with 129 slips (24 bilateral) were reviewed. Minimum follow-up was 5 years and mean follow-up was 66 months. Slips over 60 degrees were considered grade 3. All of the patients underwent in situ pinning with a single cannulated screw; the placement of the screw was evaluated with the criteria of Stambough. The final evaluation was performed using the Iowa Hip Score and results were analyzed by sex, age at time of diagnosis, and body mass index. Statistical analysis was carried out using the Mann-Whitney U-test considering a P value of less than 0.005 to be statistically significant. RESULTS: The mean Iowa Hip Score was 84.73. Fifty-two patients were considered to have an excellent result, 28 a good result, 16 a fair result, and 9 a bad result. The pin placement was considered adequate in 89 patients and inadequate in 16 patients. Forty-three patients were girls and 62 were boys and no statistical difference was found in function by sex. The mean Iowa Hip Score for patients under 12 years of age (n=20) was 85.8, for those between 12 and 15 years of age (n=69) it was 82.8 and for those over 15 years of age (n=16) it was 82.5 (P=0.003). There were 10 complications, all in the group in which the pin placement was considered inadequate, and all of these were considered fair or poor results. CONCLUSIONS: The functional results in the mid-term for patients with grade 3 slips treated with in situ pinning were generally good or excellent; a better result was found in patients below 12 years of age. A good or excellent result can be expected when pin placement is adequate and no complications arise.

PURPOSE: We sought to determine if a varus-producing osteotomy of the proximal femur was related to a better outcome than non-operative treatment for LCP disease. METHODS: This was a retrospective review of 121 patients; clinical outcome was determined with the Iowa Hip Score, and radiographic outcome was determined with the Stulberg classification. RESULTS: A total of 73 patients undergoing a VO and 48 treated non-operatively were included; 70 had lateral pillar type B and 51 type C hips. Average follow-up was 12.03 years. The mean Iowa Hip Score was 86.8 for the VO group and 85.9 for the non-operative group. According to the Stulberg classification for the group undergoing a VO, there were 8 type II, 33 type III, and 32 type III, and for the group undergoing non-operative treatment there were 11 type II, 24 type III, and 13 type IV. CONCLUSIONS: We found no statistically significant difference in the clinical or radiographic result for patients undergoing a VO compared to non-operative treatment.

BACKGROUND: It is generally accepted that the presence of angular deformity about the knee that persists into the preadolescent years will not correct spontaneously. The goal of this study was to review our experience with hemiepiphysiodesis and physeal stapling for the correction of angular deformity to establish the efficacy of these procedures and to determine their indications and the rate of correction. METHODS: A retrospective review of 48 patients undergoing hemiepiphysiodesis or physeal stapling about the knee was performed. Patients were included if they had at least 2 years of documented follow-up without an osteotomy. RESULTS: The average follow-up was 30.4 months (range, 24-52 months). Genu varum was identified in 33 patients, genu valgum in 14 patients, and a windswept deformity in 1. Of the 52 limbs with genu varum, 35 were secondary to Blount disease. The group with genu varum unrelated to Blount disease presented a change in the mechanical axis from a mean of -32 degrees at surgery to a mean of - 13 degrees. The patients with Blount disease presented a change in the mechanical axis from a mean of -19 degrees at surgery to a mean of -16 degrees. The group with genu valgum presented a change in the mechanical axis from a mean of 20 degrees at surgery to a mean of 2 degrees. CONCLUSIONS: Hemiepiphysiodesis is an effective means for correcting angular deformity about the knee in skeletally immature patients with both genu valgum and genu varum, so long as the genu varum is unrelated to Blount disease. Hemiepiphysiodesis is effective in preventing the progression of deformity in patients with Blount disease. LEVEL OF EVIDENCE: Therapeutic-Level IV.