PubMed · 13028440
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R CLEMENT. 1952-11-10. [Chondrodystrophy].. https://pubmed.ncbi.nlm.nih.gov/13028440/
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BACKGROUND: Screening for developmental dysplasia of the hip (DDH) is widely recommended for all infants to prevent disability from late diagnosis of dislocation of the hip. The present study evaluates the results of screening for developmental dislocation of hip in a clinic in Turkey over the course of 7 years. METHODS: Hospital records of 5798 infants who were examined regularly until walking age at Gazi University well child clinics between January 1995 and December 2001 were reviewed. Infants with known risk factors for DDH such as breech presentation, family history of DDH or swaddling, and of infants with physical examination findings suggestive of DDH, were referred to orthopedic surgeons for diagnosis. Based on this final diagnosis, sensitivity, specificity, positive and negative predictive values of risk factors and physical examination findings were calculated. RESULTS: Of the 5798 infants, risk factors were detected in the medical history of 111 infants, and in 14 infants a musculoskeletal deformity was detected. In 606 infants the physical examination findings were suggestive of DDH. Ten patients were subsequently diagnosed with DDH. The sensitivity, specificity, positive predictive value and negative predictive values of having a risk factor for DDH in history were 10.0%, 98.1%, 0.9%, 99.8%, and having abnormal hip examination findings were 100.0%, 88.9%, 1.6% and 100.0%, respectively. CONCLUSIONS: A careful history and physical examination is the cornerstone of DDH screening. Serial hip examinations performed during health examination visits provide an opportunity to identify DDH cases. The sensitivity of risk factors in history and physical examination findings together is high enough to be accepted as a screening tool.
Acetabular dysplasia is a major precursor of osteoarthritis of the hip. It is important to identify patients before the development of osteoarthritis, because these patients may be candidates for joint-preserving surgery, such as pelvic osteotomy. Patients with hip dysplasia, and no osteoarthritis, present with unique findings on history and physical examination. On history, patients should be questioned for symptoms unique to dysplasia, such as locking, snapping, and feelings of instability. Physical examination should look for signs of labral disease, by using the impingement test. Patients suspected of having symptomatic dysplasia should have plain radiographs, including an anteroposterior radiograph of the pelvis taken with the patient standing, a false profile view, and an abduction view of the hip. The anteroposterior radiograph of the pelvis and false profile view will help to quantify the degree of the dysplasia. The abduction view is important in determining the patient's eligibility for joint-preserving hip surgery. Computed tomography scanning and magnetic resonance imaging are reserved for patients who are operative candidates. Computed tomography scanning can aid in the planning of complex pelvic osteotomies. Magnetic resonance imaging especially is useful for delineating labral disease. It is this combination of history, physical examination, and radiographic workup that will allow successful treatment of the dysplastic hip before the development of osteoarthritis.
Vascularized fibular grafts have proved reliable in the treatment of congenital pseudarthrosis of the tibia with a high success rate. However, severe shortening cannot be primarily corrected by this technique and requires a second-stage lengthening procedure. Ilizarov's method allows correction of shortening and axial malalignment together with the non-union. However, in the dysplastic type with severe shortening, corticotomy of the affected bone may result in delayed consolidation or recurrence of disease. In addition, the large distraction distance (equal to the amount of shortening plus the resulting defect after excision of the pseudorthrosis site) requires prolonged frame application, which may not be tolerated by the patient. We present a new technique combining vascularized fibular graft and Ilizarov distraction that allows simultaneous correction of shortening while treating the non-union in a single-stage operation. This method avoids corticotomy in the congenitally affected bone and markedly shortens the time of frame application.