Prevalence and radiological definitions of acetabular dysplasia after the age of 2 years:a systematic review

Acetabular dysplasia is one of the most common causes of early hip osteoarthritis and hip replacement surgery. Recent literature suggests that acetabular dysplasia does not always originate at infancy, but can also develop later during childhood. This systematic review aims to appraise the literature on prevalence numbers of acetabular dysplasia in children after the age of 2 years. A systematic search was performed in several scientific databases. Publications were considered eligible for inclusion if they presented prevalence numbers on acetabular dysplasia in a general population of healthy children aged 2–18 years with description of the radiological examination. Quality assessment was done using the Newcastle-Ottawa score. Acetabular dysplasia was defined mild when: the center-edge angle of Wiberg (CEA-W) measured 15–20°, the CEA-W ranged between -1 to -2SD for age, or based on the acetabular index using thresholds from the Tönnis table. Severe dysplasia was defined by a CEA-W < 15°, <-2SD for age, or acetabular index according to Tönnis. Of the 1837 screened articles, four were included for review. Depending on radiological measurement, age and reference values used, prevalence numbers for mild acetabular dysplasia vary from 13.4 to 25.6% and for severe acetabular dysplasia from 2.2 to 10.9%. Limited literature is available on prevalence of acetabular dysplasia in children after the age of 2 years. Prevalence numbers suggest that acetabular dysplasia is not only a condition in infants but also highly prevalent later in childhood

The association of BMI and physical activity on acetabular dysplasia in children

Background: Acetabular dysplasia is an important pre-disposing factor for osteoarthritis of the hip. However, it is not completely known how acetabular dysplasia develops during childhood. Objective: To study the prevalence of acetabular dysplasia and its association with body mass index (BMI) and physical activity in 9 year old children. Design: The population for this cross-sectional study was drawn from the ongoing prospective cohort study: Generation R. 9,778 mothers with a delivery date from March 2002 until January 2006 were enrolled. In a random subgroup of these children Dual-energy X-ray absorptiometry (DXA) scanning was performed at age 9. Exposures: BMI, standardized for the Dutch population and categorized in four groups based on extended international Obesity Task Force cut-offs: underweight, normal, overweight and obesity. Physical activity was based on time spent on playing outdoors, playing sports and walking/cycling to school. Main outcomes and measures: The degree of acetabular dysplasia was determined with the centre-edge angle (CEA) and acetabular depth-width ratio (ADR) in DXA images of the hip. Results: 1,188 DXA images of children's hips were available for analysis. The median age of the children was 9.86 years. Prevalence of dysplasia and mild dysplasia was respectively 6.3%; 25.6% with CEA and 4.8%; 25.0% with ADR. BMI was negatively associated with mild dysplasia (OR 0.80 CI 0.71–0.90). Obese children showed less mild dysplasia compared to normal children (OR 0.48 CI 0.24–0.97) in unadjusted analysis. Physical activity represented by walking to school showed a statistically significant negative association with mild dysplasia (OR 0.87 CI 0.76–0.99). After adjustment for age, ethnicity, sex, first born, breech presentation, birthweight, gestational age and Caesarean section, the patterns of association with dysplasia remained for both BMI and physical activity. Conclusions: In this study, being overweight and light physical activity were negatively associated with the development of (mild) acetabular dysplasia at the age of 9 years.</p

Uniform nomenclature for the mitochondrial contact site and cristae organizing system

The mitochondrial inner membrane contains a large protein complex that functions in inner membrane organization and formation of membrane contact sites. The complex was variably named the mitochondrial contact site complex, mitochondrial inner membrane organizing system, mitochondrial organizing structure, or Mitofilin/Fcj1 complex. To facilitate future studies, we propose to unify the nomenclature and term the complex "mitochondrial contact site and cristae organizing system" and its subunits Mic10 to Mic60

The Effect of Traction before Closed Reduction in Patients with Developmental Dysplasia of the Hip

Developmental dysplasia of the hip (DDH) with a dislocated hip can be treated with traction before closed reduction (CR). Currently, there is insufficient evidence supporting the use of preoperative traction treatment for a successful CR. The objective of this study was to determine the effect of preoperative traction on the success rate of primary CR in DDH patients with dislocated hips. A retrospective pair-matched study was performed in DDH patients with dislocated hips. Patients with preoperative traction treatment prior to primary CR were matched (based on age and the severity of DDH on the radiograph) to patients without preoperative traction treatment. The primary outcome was the presence or absence of maintained reduction after three weeks. A match was found for 37 hips, which resulted in the inclusion of 74 hips. No significant difference was found in the number of successful reductions after three weeks between the traction group and the control group (31 vs. 33 hips, p = 0.496). Traction treatment did not significantly improve the short-term or mid-term outcomes for closed reduction. Based on these results, we suggest that traction treatment should not be used as standard care for dislocated hips in DDH

Residual Hip Dysplasia in Children With Unilateral Hip Dislocation-Does Side Matter?

BACKGROUND: Developmental dysplasia of the hip (DDH) is the most common musculoskeletal abnormality in infants and young children. Despite the fact that the left hip is most frequently affected, literature and clinical experience suggest a poorer outcome for right-sided hip dislocation in DDH. On the basis of this hypothesis, we studied the outcomes (residual dysplasia, number of surgeries, and complication rate) of right-sided unilateral hip dislocation in comparison with left-sided unilateral hip dislocation in DDH up to 8 years follow-up. METHODS: We identified all patients with unilateral hip dislocation at Erasmus MC Sophia Children's Hospital from 2002 to 2012, diagnosed with DDH before the age of 1 year and with a minimum follow-up of 8 years. The primary outcome was residual dysplasia (based on an acetabular index (AI) >18 degrees and center-edge angle of Wiberg (CEA) <15 degrees) at the age of 8 years. Secondary outcome measures were residual dysplasia at the ages of 1, 2, and 5 years, successful surgical reduction rates, additional surgery, and complication rates. RESULTS: Out of a consecutive series of 555 patients, 298 could be included (17 males; median age at diagnosis 4.0 [IQR 3.0 to 5.5] months): 107 patients (35.9%) had right-sided unilateral hip dislocation. There was no significant difference in residual dysplasia between the unilateral left-sided and unilateral right-sided hip dislocation groups, respectively, at 1-year follow-up (34.0% vs. 24.2%, P =0.107), 2-year follow-up (74.1% vs. 70.1%, P =0.565), 5-year follow-up (74.1% vs. 66.2%, P =0.261), and 8-year follow-up (65.3% vs. 53.8%, P =0.199). There was no significant difference in surgical interventions between the left-sided and right-sided hip dislocation groups, respectively: additional surgical reduction (14.7% vs. 15.0%, P =0.945) and additional surgery for residual dysplasia (8.9% vs. 10.3%, P =0.695). There was no significant difference in complication rate between the unilateral left-sided and unilateral right-sided hip dislocation groups, respectively: avascular necrosis (19.4% vs. 15.9%, P =0.454) and redislocation (11.5% vs. 9.3%, P =0.561). CONCLUSIONS: The results of our study suggest that in patients with DDH, unilateral right-sided hip dislocation does not have poorer outcomes compared with unilateral left-sided hip dislocation during an 8-year follow-up. LEVEL OF EVIDENCE: Level III - retrospective follow-up study

The Predictive Value of Radiographs and the Pirani Score for Later Additional Surgery in Ponseti-Treated Idiopathic Clubfeet, an Observational Cohort Study

There are few validated predictors of the need for additional surgery in idiopathic clubfeet treated according to the Ponseti method. Our aim was to examine if physical examination (Pirani score) and radiographs at the age of three months (after initial correction of the clubfeet) can predict the future need for additional surgery. In this retrospective cohort study, radiographs of idiopathic clubfeet were made at the age of three months. The Pirani score was determined at the first cast, before tenotomy, and at the age of three months. Follow-up was at least five years. The correlation between the radiograph, Pirani score, and the need for additional surgery was explored with logistic regression analysis. Parent satisfaction was measured with a disease-specific instrument. The study included 72 clubfeet (50 children) treated according to the Ponseti method. Additional surgery was needed on 27 feet (38%). A larger lateral tibiocalcaneal angle (i.e., equinus) and a smaller lateral talocalcaneal angle (i.e., hindfoot varus) at the age of three months were correlated with the need for additional surgery. Higher Pirani scores before tenotomy and at the age of three months also correlated with additional surgery. Parent satisfaction was lower in patients who needed additional surgery. Both the Pirani scores and the lateral radiographs are predictive for future additional surgery

Post-traumatic disturbance of the epiphysis of the humeral trochlea: a spectrum of pathology

Background: Hegemann disease and fishtail deformity are classified as growth disturbances in the physeal plate of the humeral trochlea. It is questionable if these 2 diseases should be considered as 2 distinct conditions. The aims of this study are to (1) point out similarities between both conditions, (2) discuss etiology, and (3) provide diagnostic tools. Methods: In a multicenter prospective cohort study, 19 patients with growth disturbance of the humeral trochlea were included. Assessment consisted of a detailed history, physical examination, and standard radiographs in 2 directions. The radiographs were evaluated for skeletal age, carrying angles, and trochlear notch angles. Statistical analysis was performed using Stata. Results: A total of 19 patients were included: 2 males (11%) and 17 females (89%). The mean age of the patients was 12.8 years. In 17 patients (89%), a traumatic injury of the elbow was reported, before presentation. Decreased trochlear notch angle (<104°) was seen in 16 patients (84%). Accelerated closure of the growth plate of the affected elbow was seen in all skeletally immature patients. Conclusions: The main risk factor for both Hegemann disease and fishtail deformity is an injury of the elbow with open growth plates. Imaging studies support the hypothesis that both diseases are likely to be a continuum of the same process. Therefore, we propose to use 1 nomenclature for this pathologic process: post-traumatic disturbance of the epiphysis of the humeral trochlea

Active monitoring versus an abduction device for treatment of infants with centered dysplastic hips:study protocol for a randomized controlled trial (TReatment with Active Monitoring (TRAM)-Trial)

BackgroundDevelopmental Dysplasia of the Hip (DDH) is one of the most common pediatric orthopedic disorders, affecting 1–3% of all newborns. The optimal treatment of centered DDH is currently under debate. This randomized controlled trial aims to study the (cost-)effectiveness of active monitoring versus abduction treatment for infants with centered DDH. Methods This is a multicenter, parallel-group, open-label, non-inferiority randomized controlled trial studying the (cost-)effectiveness of active monitoring versus abduction treatment for infants with centered DDH in fourteen hospitals in the Netherlands. In total, 800 infants with centered DDH (Graf IIa-/IIb/IIc), aged 10–16 weeks, will be randomly allocated to the active monitoring or abduction treatment group. Infants will be followed up until the age of 24 months. The primary outcome is the rate of normal hips, defined as an acetabular index lower than 25 degrees on an antero-posterior radiograph, at the age of 12 months. Secondary outcomes are the rate of normal hips at the age of 24 months, complications, time to hip normalization, the relation between baseline patient characteristics and the rate of normal hips, compliance, costs, cost-effectiveness, budget impact, health-related quality of life (HRQoL) of the infant, HRQoL of the parents/caregivers, and parent/caregiver satisfaction with the treatment protocol. DiscussionThe outcomes of this randomized controlled trial will contribute to improving current care-as-usual for infants with centered DDH

Congenital Forearm Pseudarthrosis, a Systematic Review for a Treatment Algorithm on a Rare Condition

Background: A congenital forearm pseudarthrosis is a rare condition and is strongly associated with neurofibromatosis type 1. Several surgical techniques are described in the literature, but the most optimal treatment strategy remains unclear. This systematic review aims to develop a treatment algorithm that may aid in clinical decision making. Methods: The PROSPERO registration number for this study was CRD42018099602 and adheres to the PRISMA guidelines for systematic reviews. Embase, MEDLINE, Cochrane Central, Web of Science, and Google Scholar databases were searched for published studies reporting on congenital forearm pseudarthrosis not related to other underlying pathologies like bacterial infection or fibrous dysplasia. Results were not restricted by date or study type, only English literature was allowed. Studies were assessed for quality using the critical appraisal checklist for case reports from the Joanna Briggs Institute. Patient characteristics, underlying disease, type of surgery, union rate, and functional outcome were extracted from included studies. Results: Of 829 studies identified, 47 were included in this review (17 case series and 30 case reports, a total of 84 cases). A onebone forearm procedure showed highest union rates (92%), however, it results in loss of forearm rotation. Free vascularized fibula grafting showed high union rates (87%) and was related to good functional outcome of elbow flexion and forearm rotations. Other procedures showed disappointing outcomes. Conclusions: Congenital forearm pseudarthrosis is best treated with a free vascularized fibula grafting, a one-bone forearm procedure should be used as a salvage procedure. Evidence extracted from the case reports was sufficient to generate a treatment algorithm to be used in clinical pediatric practice. Level of Evidence: Level IV-therapeutic