Biomedical subjects

M B Millis

Publications and source records attributed to M B Millis.

39 records · Page 3Linked to original sources

PubMedDate not supplied

The Pavlik harness and developmental dysplasia of the hip: has ultrasound changed treatment patterns?

Monitoring Pavlik harness therapy for developmental dysplasia of the hip (DDH) has been used at our institution since 1986. In this study, we compared Pavlik therapy for DDH without ultrasound monitoring (group A) to similar therapy with ultrasound monitoring (group B). Both groups had similar age at diagnosis. Treatment failure was recognized earlier in group B than in group A (4.9 vs. 9.3 weeks). The total number of radiographs was significantly decreased in group B. The duration of therapy was less in group B than in group A. Successfully treated hips had an average increase in alpha angle of 8.4 degrees per month. The average failure rate in hips resting in a dislocated position at the onset of Pavlik therapy was unchanged by Pavlik monitoring.

Braces↗

PubMedDate not supplied

Osteonecrosis of the femoral head associated with slipped capital femoral epiphysis.

We performed a retrospective analysis of 212 patients (299 hips) with slipped capital femoral epiphysis (SCFE) over a 9-year period to assess the incidence of osteonecrosis of the femoral head. Risk factors for the occurrence of osteonecrosis and the influence of treatment on the development of osteonecrosis were determined. Osteonecrosis occurred in 4 hips with unstable SCFE (4/27) and did not occur in hips with stable SCFE (0/272). The proportion of hips in which osteonecrosis developed was significantly higher among the unstable hips (4/27 vs. 0/272, p < 0.0001). Among those with an unstable hip, younger age at presentation was a predictor of a poorer outcome. Magnitude of the slip, magnitude of reduction, and chronicity of the slip were not predictive of a poorer outcome in the unstable group. In situ fixation of the minimally or moderately displaced "unstable" SCFE demonstrated a favorable outcome. We have identified the hip at risk as an unstable SCFE. The classification of hips as unstable if the epiphysis is displaced from the metaphysis or if the patient is unable to walk is most useful in predicting a hip at risk for osteonecrosis.

Age Factors↗

PubMedDate not supplied

Early failure of Pavlik harness treatment for developmental hip dysplasia: clinical and ultrasound predictors.

A cohort of 93 patients with developmental dysplasia of the hip (DDH) treated with a Pavlik harness were evaluated to determine predictors of treatment failure. Failure was defined as failure to achieve or maintain hip reduction in the Pavlik harness. Of 93 patients (137 hips), 17 (26 hips) failed Pavlik harness treatment. Univariate risk factors for failure included bilaterality, initial clinical exam, and initial ultrasound (US) percent coverage. Clinical exam and initial percent coverage were multivariate risk factors for failure. Among initially clinically dislocatable hips, a low initial US alpha angle correlated with an increased likelihood of failure. All (6/6) patients with an initially irreducible hip and an initial coverage of <20% by US eventually failed treatment. Gender, side of pathology, and age at diagnosis and initiation of treatment did not correlate with failure. Irreducibility by physical exam combined with US coverage of <20% identified a patient group that uniformly failed Pavlik harness treatment. These patients may be candidates for alternative bracing, traction, or closed or open reduction.

Age Factors↗