We examined the causes of iatrogenic avascular necrosis of the femoral head in 254 hips with congenital dislocation (CDH) treated conservatively. The influence of the age of the child, the height of the displacement of the femoral head, the extent of acetabular dysplasia, and the method of treatment on the frequency and degree of necrosis were estimated. The investigation showed that children are at the highest risk of iatrogenic necrosis in the following cases: (a) age less than 6 months, (b) severe acetabular dysplasia, (c) use of an abduction apparatus such as the Frejka pillow for outpatients, and (d) "frog-leg" position after reduction.

Age Factors↗

PubMedDate not supplied

Intraarticular bleeding in children with hemophilia: the prevention of arthropathy.

The treatment of about 400 hemorrhages in the joints of 46 children with hemophilia A are described. The procedures varied according to the location and seriousness of the bleeding and the level of the clotting factor. We always transfused just enough cryoprecipitate to obtain a hemostatic level of factor VIII. When necessary, we would remove blood from the joint. Physical therapy was instituted. The average follow-up period after the initial intra-articular bleeding was 15 years. In patients with a severe form of hemophilia, only 24% of the affected knee joints were in stages III, IV, or V of arthropathy, which should be regarded as a positive result of treatment. We confirmed advanced arthropathy in 21% of the affected elbow joints. Arthropathy occurred only rarely in ankle joints. These results compare favorably to the results obtained among patients undergoing preventative infusions of factor VIII at home.

Child, Preschool↗

PubMedDate not supplied

Experience in the conservative treatment of congenital clubfoot in newborns and infants.

We studied 323 children with congenital clubfoot from 1970 to 1987. The principles of conservative treatment of congenital clubfoot in newborns have completely changed since 1973. The present principles we follow are to begin treatment immediately after birth; and adduction and varus removal by manipulation. In each case, we use a plaster cast, which is changed after a few days as long as the foot is limp and well corrigible. The knee is immobilized at 60 to 70 degrees in a plaster cast. During the manipulations, the surgeon's hand presses only the plantar side of the foot. The results can be described as good, since in each child we have removed adduction and varus as operation by posterior release and Achilles lengthening was necessary in only 50% of the children.

Casts, Surgical↗

PubMedDate not supplied

Double-elevating osteotomy of tibiae in the treatment of severe cases of Blount's disease.

The results of operative correction of 13 cases of tibia vara in 10 children with advanced infantile Blount's disease are presented. All of the children were operated by "double-elevating" osteotomy. An essential element of this procedure was the reconstruction of the horizontal level of the medial tibial plateau. The average follow-up after treatment was 8 years 1 month. We recommend this method of osteotomy in cases of considerable depression of the medial tibial condyle with the defect of epiphyseal bone and as a bone bridge between the metaphysis and the epiphysis.

Acute Disease↗