Search

Controversy exists regarding the role of pelvic obliquity in hip dysplasia and cerebral palsy. Earlier authors noted such a relationship but did not confirm its existence by scientific study. The current study confirms the association of pelvic obliquity to hip dysplasia in spastic cerebral palsy. At presentation of subluxation or dislocation before surgery, 80 patients were indexed into 5 body alignment types. Reclassifications were performed with passage of time to study the natural history and effects of surgery. Hip dysplasia was found in all cases to be consistent with the forces related to pelvic obliquity.

Early spica cast treatment is one method used for children's femoral shaft fractures; it is increasingly advocated as treatment that allows early hospital discharge. The outcome of early spica cast treatment in 100 children, ages 2 to 10 years, with uncomplicated and isolated closed femoral shaft fractures treated at Johns Hopkins Hospital between October 1987 and March 1994 were analyzed. The objective was to identify those children who can be treated safely and dependably with early spica casting without excessive shortening of the fracture fragments. Eighty-one (81%) children had an acceptable outcome and 19 (19%) had an unacceptable outcome by the definition of more than 25 mm of fracture fragment overlap after clinical healing. A new clinical test, the telescope test, was statistically significant for correlation with spica cast outcome. Age, gender, fracture, location, mechanism of injury, fracture type, and resting radiograph of fracture fragment overlap were not statistically significant. The telescope test had a sensitivity of 80% and a specificity of 85% for predicting outcome. The relative risk for failure of spica cast treatment with a positive telescope test was 20.4 (95% confidence limits = 2.7-225.1). Children 2 to 10 years of age with uncomplicated femoral shaft fractures and a negative telescope test can be treated appropriately in most cases with early application of a spica cast.