Daniel Augusto Maranho1,2, Felipe Nunes Donati3, Vitor Faeda Dalto3, Marcello Henrique Nogueira-Barbosa4,3. 1. School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, No. 3900, Monte Alegre, Ribeirão Preto, State of São Paulo, 14048-900, Brazil. dacmaranho@gmail.com. 2. Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Clinical Hospital of Ribeirão Preto, 11th floor, Ribeirão Preto, Brazil. dacmaranho@gmail.com. 3. Musculoskeletal Radiology, School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, No. 3900, Monte Alegre, Ribeirão Preto, State of São Paulo, 14048-900, Brazil. 4. School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, No. 3900, Monte Alegre, Ribeirão Preto, State of São Paulo, 14048-900, Brazil.
Abstract
OBJECTIVE: To evaluate the evolution of the ultrasonographic pubo-femoral distance (PFD) before and after Pavlik harness treatment for developmental dysplasia of the hip (DDH) in newborns. PATIENTS AND METHODS: Twenty-five patients (16.7 ± 10.4 days; 19 females, six males) diagnosed with DDH and treated using the Pavlik harness were included. Eighteen patients had bilateral, and seven unilateral DDH, with a total of 43 dysplastic hips. The seven non-dysplastic hips in unilateral cases were used for comparison. The PFD was measured in the coronal and axial planes with the hip flexed to approximately 90°, before and after an average of 93 days of treatment. The femoral head coverage was assessed in the coronal plane, and correlated with PFD values. RESULTS: In dysplastic hips, the mean PFD decreased from 6.1 ± 1.8 mm to 3.0 ± 0.7 mm in the axial (adjusted difference, 2.9 mm; p < 0.01), and from 5.9 ± 2.0 to 3.0 ± 0.6 mm in the coronal plane (adjusted difference 2.7 mm; p < 0.01). The femoral head coverage increased from 30.8 to 62.1%, and the mean differences of femoral head coverage and PFD were significantly correlated (p < 0.001). There was no difference between treated dysplastic and non-dysplastic hips. There was high intra- and inter-observer agreement for PFD measurements. CONCLUSION: The PFD decreased significantly after DDH treatment using the Pavlik harness in newborns, and showed significant correlation with the femoral head coverage improvement. PFD might be a reliable tool for monitoring DDH treatment in newborns treated using the Pavlik harness.
OBJECTIVE: To evaluate the evolution of the ultrasonographic pubo-femoral distance (PFD) before and after Pavlik harness treatment for developmental dysplasia of the hip (DDH) in newborns. PATIENTS AND METHODS: Twenty-five patients (16.7 ± 10.4 days; 19 females, six males) diagnosed with DDH and treated using the Pavlik harness were included. Eighteen patients had bilateral, and seven unilateral DDH, with a total of 43 dysplastic hips. The seven non-dysplastic hips in unilateral cases were used for comparison. The PFD was measured in the coronal and axial planes with the hip flexed to approximately 90°, before and after an average of 93 days of treatment. The femoral head coverage was assessed in the coronal plane, and correlated with PFD values. RESULTS: In dysplastic hips, the mean PFD decreased from 6.1 ± 1.8 mm to 3.0 ± 0.7 mm in the axial (adjusted difference, 2.9 mm; p < 0.01), and from 5.9 ± 2.0 to 3.0 ± 0.6 mm in the coronal plane (adjusted difference 2.7 mm; p < 0.01). The femoral head coverage increased from 30.8 to 62.1%, and the mean differences of femoral head coverage and PFD were significantly correlated (p < 0.001). There was no difference between treated dysplastic and non-dysplastic hips. There was high intra- and inter-observer agreement for PFD measurements. CONCLUSION: The PFD decreased significantly after DDH treatment using the Pavlik harness in newborns, and showed significant correlation with the femoral head coverage improvement. PFD might be a reliable tool for monitoring DDH treatment in newborns treated using the Pavlik harness.
Entities:
Keywords:
Braces; Congenital hip dysplasia; Diseases; Hip dislocation, congenital; Infant; Newborn; Treatment outcome; Ultrasonography
Authors: David P Gwynne Jones; Andrew G S Vane; Gareth Coulter; Peter Herbison; John D Dunbar Journal: J Pediatr Orthop Date: 2006 Nov-Dec Impact factor: 2.324
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