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Background: Pavlik harness is the most widely used orthosis in the treatment of developmental dysplasia of the hip. The aim of this study was to evaluate the effect of the Pavlik harness on the development of "unaided sitting" and "independent walking" in infants with developmental dysplasia of the hip. Methods: This prospective study, conducted from 2017 to 2020, included infants undergoing Pavlik harness therapy. Inclusion criteria comprised gestational age > 37 weeks, treatment initiation before 6 months of age, and no prior treatment for developmental dysplasia of the hip. We assessed treatment initiation age, treatment duration, and the age of achieving unaided sitting and independent walking. Results: In the patient group, unaided sitting commenced at a mean age of 6.8 ± 1.6 (range: 4–11) months, while independent walking began at a mean age of 12.7 ± 1.8 (range: 9–18) months. By 15 months, 92% of the patients achieved independent walking. In the control group, unaided sitting occurred at a mean age of 6.1 ± 1.1 (range: 4–8) months, and independent walking at 11.8 ± 1.6 (range: 9–18) months. A significant positive correlation was observed between the duration of Pavlik harness usage and the age of unaided sitting (p < 0.001) and independent walking (p < 0.001). Conclusion: Our study indicates that Pavlik harness treatment for developmental dysplasia of the hip is generally safe and does not lead to clinically significant delays in unaided sitting and independent walking. However, some minor delays may occur due to extended orthosis use. Level of evidence: level III—prospective cohort study. [ABSTRACT FROM AUTHOR]

To evaluate the relationship between radiological and clinical evaluation instruments used in children with flexible pes planus (FPP) with quality of life and functional scores. The study group consisted of sixteen children with FPP (mean age: 9.8 1.1 years). The patients were examined in detail using static pedobarography with the Win- Track system. A physical examination was also undertaken using the Foot Posture Index-6 (FPI-6). The four angles were measured on foot radiographs. For functional evaluation, the Pediatric Outcomes Data Collection Instrument (PODCI) score was employed. A single experienced rehabilitation specialist performed Beighton scoring. No correlation was found between the FPI-6 clinical rating scale and Beighton scores, radiographic data, and pedobarographic evaluation. The PODCI and Beighton scores, on the other hand, had a negative connection (P=0.000, r=-0.781). The radiological, clinical, and pedobarographic values were not correlated with the PODCI functional score. In the management of patients with FPP, the commonly used FPI-6, radiographic and pedobarographic measurements were not correlated with the PODCI functional score. However, children with extensive joint laxity are more likely to have functional limitations. Therefore, it is important to evaluate children with FPP in terms of common joint laxity before treatment planning. [ABSTRACT FROM AUTHOR]

Objectives: Achilles tendon lengthening (ATL) is one of the most commonly performed procedures in paediatric orthopaedic surgery. An appropriate adjustment of the amount of ATL is crucial to avoid insufficient or excessive lengthening. However, there is currently no effective method to preoperatively calculate the tendon length needed for equinus deformity correction. Thus, in this study we evaluated the accuracy of a calculation using a mathematical model based on the law of cosines.Methods: A total of 16 feet of 14 patients who were scheduled for ATL surgery due to equinus deformity were included in the study. ATL surgery was performed using a standard Z-plasty technique. Calculation of the amount of ATL using the law of cosines, and assessments of intraoperative lengthening of the tendon, were performed in a double-blind manner. The extent of lengthening resulting from the two methods was then compared.Results: The mean ATL determined intraoperatively was 23.67 ± 8.7 mm, and that obtained using the cosine-based method was 22.49 ± 8.6 mm. Thus, the new method showed excellent statistical agreement with the actual lengthening performed during surgery.Conclusions: The required dimension of ATL can be calculated preoperatively using the mathematical formula presented here. The advantages of this approach are that it allows accurate tendon lengthening and reduces the size of the surgical incision. [ABSTRACT FROM AUTHOR]

Copyright of Istanbul Medical Journal is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Physical Medicine & Rehabilitation / Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi is the property of Turkish Society of Physical Medicine & Rehabilitation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Salter osteotomy and Tonnis lateral acetabuloplasty (TLA) are pelvic osteotomies with similar indications and clinical results used in the treatment of developmental dysplasia of the hip (DDH). The aim of our study was to compare the intraoperative fluoroscopy exposure time (FET) in patients with DDH treated with the Salter osteotomy and TLA. In this study, data were collected prospectively and compared after the study was completed. The patients were evaluated in three groups: pelvic osteotomy (group 1), open reduction with pelvic osteotomy (group 2) and open reduction + pelvic osteotomy + femoral shortening (group 3). Pelvic osteotomy techniques in each group were further analyzed in two subgroups as Salter osteotomy and TLA. Age, sex, surgery side, degree of dysplasia according to the Tönnis classification, duration of anesthesia and intraoperative FET (seconds) were recorded. A total of 109 patients (93 girls and 16 boys) were included in the study; 29 patients in group 1, 50 in group 2 and 30 in group 3. Although the patients who underwent Salter osteotomy and TLA were similar in all three groups in terms of age, sex, surgery side, Tönnis classification and duration of anesthesia, FET was longer in the patients who underwent TLA (group 1, P  < 0.001; group 2, P  < 0.001; group 3, P  = 0.005). The use of the Salter osteotomy technique in the treatment of acetabular dysplasia in patients with DDH seems to be more advantageous in terms of FET than TLA osteotomy. It would be beneficial to consider this result in terms of radiation safety. Level of Evidence: II., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

The aim of this study was to investigate the relationship of developmental dysplasia of the hip (DDH) with asymmetrical skin crease (ASC) in the inguinal, gluteal and thigh regions and to determine which ASC has the most predictive value for the diagnosis of hip dislocation in infants. This study was planned as a prospective, observational study and conducted between 1 October 2020 and 1 June 2021. Asymmetric distribution of skin creases was evaluated separately in three regions (inguinal, gluteal and thigh). Then, hip ultrasonography (USG) was performed and the Graf method was used to classify the cases as 'centralized' [Graf types I, IIa (-), IIb and IIc] and 'decentralized' (Graf types IId, III and IV). The relationship between the groups was evaluated using univariate and then multivariate analyses. A total of 241 patients were included in the study. The number of patients with ASC was 49 (21%). While 36 of these 49 patients had centralized hips, 13 had decentralized hips ( P  < 0.001). Sixty-five percent (13/20) of 20 infants with decentralized hips had ASC in at least one of the inguinal, gluteal or thigh regions. The presence of ASC in the inguinal ( P  < 0.001) and gluteal ( P  < 0.014) regions increased the risk of the decentralized hip in the child, whereas the presence of ASC in the isolated thigh region did not increase the risk of the dislocated hip ( P  = 0.534). Inguinal ASC and gluteal ASC are reliable findings in DDH screening, but the relationship of isolated thigh ASC with DDH could not be demonstrated statistically. Level of Evidence: Level II - diagnostic study., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: This study aims to assess the natural history of congenital posteromedial bowing of the tibia (CPMBT) deformity during growth and to evaluate the outcomes of lengthening by an Ilizarov frame in CPMBT patients with limb length discrepancy (LLD)., Patients and Methods: Between January 2000 and December 2019, a total of 22 patients (12 males, 10 females; mean age: 10.5±4.4 years; range, 6 to 19 years) with the diagnosis of CPMBT and followed closely from birth until skeletal maturity were retrospectively analyzed. The radiographic evaluation included the anteroposterior and lateral interphyseal angle and full leg standing radiographs. Limb lengthening by an Ilizarov frame was performed for an estimated LLD over 40 mm., Results: The age of the patients ranged from six days to 10 months at the time of presentation, while the mean age at the final follow-up was 10.5±4.4 years. Posterior medial bowing was satisfactorily remodeled in 13 (59%) patients those were not operated either for deformity or LLD. The mean LLD was 21±4.1 mm in 13 nonoperated CPMBT patients. Nine of 22 (41%) patients underwent lengthening for LLD. Five of the nine CPMBT patients were operated under the age of 10 years, while four were operated over the age of 10 years., Conclusion: According to the results of the current study, CPMBT was satisfactorily remodeled in more than half of the patients, and the majority of patients did not undergo surgery for angular deformity and LLD within 10 years of their lives. Based on these findings, although most of the patients' deformities remodeled, it should be kept in mind that some may require lengthening surgery.

Objectives: The aim of this study was to evaluate correlation of post-reduction magnetic resonance imaging (MRI)-based parameters with residual acetabular dysplasia in developmental dysplasia of the hip (DDH) patients who underwent open reduction., Patients and Methods: A total of 62 hips of 54 children (5 males, 57 females; mean age: 8.5±3.5 months; range, 0 to 24 months) with a diagnosis of DDH who underwent open reduction between January 2012 and January 2017 were retrospectively analyzed. The acetabular head index (AHI), head coverage index (HCI), sphericity, bony acetabular index (BAI), cartilage acetabular index (CAI), anterior acetabular index (AAI), posterior acetabular index (PAI), abduction angle (AA), and acetabular medial wall thickness were measured by MRI. The correlation between MRI measurements and residual acetabular dysplasia was evaluated., Results: The mean follow-up was 23.7±10.1 (range, 12 to 56) months. The mean age at the final examination was 47.6±10.4 months. The age at the time of operation (r=0.250, p=0.049), medial wall thickness (r=0.304, p=0.016), AAI (r=0.729, p<0.001), PAI (r=0.590, p<0.001), and early postoperative AI (r=0.900, p<0.001) at the third postoperative month were positively correlated with the last follow-up AI. The AHI (r=-0.512, p<0.001), sphericity (r=-0,661, p<0.001), and HCI (r=-0.554, p< 0.001) were negatively correlated with the last follow-up AI., Conclusion: Post-reduction MRI parameters can be used to evaluate correlation with persistent acetabular dysplasia in DDH patients.