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Aims: To determine the likelihood of achieving a successful closed reduction (CR) of a dislocated hip in developmental dysplasia of the hip (DDH) after failed Pavlik harness treatment We report the rate of avascular necrosis (AVN) and the need for further surgical procedures. Methods: Data was obtained from the Northern Ireland DDH database. All children who underwent an attempted closed reduction between 2011 and 2016 were identified. Children with a dislocated hip that failed Pavlik harness treatment were included in the study. Successful closed reduction was defined as a hip that reduced in theatre and remained reduced. Most recent imaging was assessed for the presence of AVN using the Kalamchi and MacEwen classification. Results: There were 644 dislocated hips in 543 patients initially treated in Pavlik harness. In all, 67 hips failed Pavlik harness treatment and proceeded to arthrogram (CR) under general anaesthetic at an average age of 180 days. The number of hips that were deemed reduced in theatre was 46 of the 67 (69%). A total of 11 hips re-dislocated and underwent open reduction, giving a true successful CR rate of 52%. For the total cohort of 67 hips that went to theatre for arthrogram and attempted CR, five (7%) developed clinically significant AVN at an average follow-up of four years and one month, while none of the 35 hips whose reduction was truly successful developed clinically significant AVN. Conclusion: The likelihood of a successful closed reduction of a dislocated hip in the Northern Ireland population, which has failed Pavlik harness treatment, is 52% with a clinically significant AVN rate of 7%. As such, we continue to advocate closed reduction under general anaesthetic for the hip that has failed Pavlik harness. Cite this article: Bone Jt Open 2021;2(8):594–598.

Compositions of rare mineral phases containing precious metals (PMs) in samples from Natalka, Pavlik, Vetrenskoe, and Degdekan gold ore deposits (North-East of Russia) are studied by scintillation atomic emission spectrometry (SAES) and electron probe microanalysis (scanning electron microscopy and electron probe X-ray microanalysis, SEM-EPMA). The SAES method found dozens and hundreds of particles carrying gold, silver, and all platinum-group elements as native metals, intermetallides and solid solutions, arsenides, antimonites, sulfoarsenides, tellurides, selenides, etc. The variety of the elemental compositions of PM species (mineral phases) found by SAES significantly exceeds the list of minerals found previously by SEM-EPMA because of different natures of optical and X-ray spectra. The sizes of PM particles calculated by the SAES method and measured by SEM-EPMA are similar. The SAES data on the total concentrations of PMs satisfactorily agree with the results of inductively coupled plasma mass spectrometry. [ABSTRACT FROM AUTHOR]

Background: Predictors of failure of the Pavlik harness in reducing and stabilizing an Ortolani-positive hip remain 'unclear'. The purpose of this study is to investigate the success of the Pavlik harness when treating Ortolani-positive hips, to look for predictors of failure of the harness and to analyze the arthrographic findings among these failures. Materials and methods: The medical records of 39 consecutive patients with an Ortolani-positive hip treated initially with a Pavlik harness were reviewed. Data regarding birth order, problems during pregnancy, presentation at birth, delivery, family history of DDH, gender, side involved, bilaterality, onset of treatment, problems related to use of the harness, and time until the harness reduced and stabilized the hip or was abandoned because of a failure were recorded. The presence of plagiocephaly, torticollis or foot deformity was also noted. We looked for predictors of failure among these aspects and report the arthrographic findings of the failures. Results: The mean age when the harness was started was 16.7 days. The mean time until success or failure of the harness in reducing and stabilize the hip was 18.5 days. There were 8 (20.5 %) failures. Multigravida ( p = 0.026) and foot deformity ( p = 0.023) were associated with failure of the harness. On the other hand, problems during pregnancy ( p = 1), presentation at birth ( p = 0.078), c-section ( p = 0.394), family history of DDH ( p = 1), gender (0.313), torticollis ( p = 1), bilaterality ( p = 1) and onset of treatment ( p = 0.485) were not associated. Arthrographic abnormalities were found in all failures. Conclusion: The Pavlik harness failed to reduce and stabilize the hip in 20.5 % of the newborns with an Ortolani-positive hip. Multigravida and foot deformity were statistically associated with failure of the harness. An anatomical obstacle for reduction was found in all hips with a harness failure. A more teratological than mechanical hip dislocation could be the reason for failure of the Pavlik harness. Level of evidence: IV, Retrospective case series. [ABSTRACT FROM AUTHOR]

Purpose: Establish whether recurrent dysplasia once a dysplastic hip has been treated to ultrasonographic normality is possible. Methods: 370 babies were referred to a hip ultrasound clinic from June 2005 to 2007 to assess for dysplasia. 96 dysplastic hips underwent appropriate treatment until normal hip morphology achieved on follow-up ultrasounds. Minimum further 12 months follow-up. Results: 3 children (4%) developed late recurrence of dysplasia. Two required a plaster hip spica. One had an additional adductor tenotomy. One required late pelvic osteotomy. Conclusion: This study highlights the need for long-term follow-up of dysplastic hips with an early pelvic X-ray at around six months. [ABSTRACT FROM AUTHOR]

The treatment of bilaterally dislocated hips with a Pavlik harness can have deleterious effects if one hip remains dislocated. We assess the success of potentially leaving the persistently dislocated hip free and the relocated hip in a “hemi-Pavlik” harness. In this report, we retrospectively review three cases of bilaterally dislocated hips in children who were treated with a Pavlik harness. Only one hip was effectively reduced by the harness and, in each case, half of the harness was cut away to create a “hemi-Pavlik” harness and the free side was operated on at a later date. Initial follow-up has shown that the “hemi-Pavlik” harness is effective in maintaining reduction of one hip whilst leaving the other hip untreated, thus, avoiding the complications of prolonged use of the harness in an unreduced hip or having both hips dealt with operatively. We suggest, in the early stages, that if only one side of the bilaterally displaced hips can be reduced, the non-reduced side should be left free and an elective procedure carried out at a later stage. In the early stages, a “hemi-Pavlik” harness is effective in treating the reducible hip and causes no treatment obstacles for the irreducible side. [ABSTRACT FROM AUTHOR]

Aims: To determine the likelihood of achieving a successful closed reduction (CR) of a dislocated hip in developmental dysplasia of the hip (DDH) after failed Pavlik harness treatment We report the rate of avascular necrosis (AVN) and the need for further surgical procedures., Methods: Data was obtained from the Northern Ireland DDH database. All children who underwent an attempted closed reduction between 2011 and 2016 were identified. Children with a dislocated hip that failed Pavlik harness treatment were included in the study. Successful closed reduction was defined as a hip that reduced in theatre and remained reduced. Most recent imaging was assessed for the presence of AVN using the Kalamchi and MacEwen classification., Results: There were 644 dislocated hips in 543 patients initially treated in Pavlik harness. In all, 67 hips failed Pavlik harness treatment and proceeded to arthrogram (CR) under general anaesthetic at an average age of 180 days. The number of hips that were deemed reduced in theatre was 46 of the 67 (69%). A total of 11 hips re-dislocated and underwent open reduction, giving a true successful CR rate of 52%. For the total cohort of 67 hips that went to theatre for arthrogram and attempted CR, five (7%) developed clinically significant AVN at an average follow-up of four years and one month, while none of the 35 hips whose reduction was truly successful developed clinically significant AVN., Conclusion: The likelihood of a successful closed reduction of a dislocated hip in the Northern Ireland population, which has failed Pavlik harness treatment, is 52% with a clinically significant AVN rate of 7%. As such, we continue to advocate closed reduction under general anaesthetic for the hip that has failed Pavlik harness. Cite this article: Bone Jt Open  2021;2(8):584-588.

Purpose: Establish whether recurrent dysplasia once a dysplastic hip has been treated to ultrasonographic normality is possible., Methods: 370 babies were referred to a hip ultrasound clinic from June 2005 to 2007 to assess for dysplasia. 96 dysplastic hips underwent appropriate treatment until normal hip morphology achieved on follow-up ultrasounds. Minimum further 12 months follow-up., Results: 3 children (4%) developed late recurrence of dysplasia. Two required a plaster hip spica. One had an additional adductor tenotomy. One required late pelvic osteotomy., Conclusion: This study highlights the need for long-term follow-up of dysplastic hips with an early pelvic X-ray at around six months.