Screening for hip abnormality in the neonate

Prognostic factors for failed Pavlik harness treatment in infants with developmental dysplasia of the hip: a retrospective cohort study

PURPOSE

Pavlik harness treatment is the most common treatment in newborns diagnosed with developmental dysplasia of the hip (DDH). The success rates and predictors for failure have been debated over the last decade. In this study, we explored our treatment failure rate and potential prognostic factors that could predict the failure of Pavlik harness (PH) treatment in patients with DDH.

METHODS

Two hundred and sixty-five patients were treated with PH based on the Graf hip types of classification. Age, gender, first born status, family history, foot deformity, plagiocephaly, breech presentation, hip abduction, hip stability, Graf hip type, Galeazzi sign, bilateralism, and femoral nerve palsy were tested as predictors for failure in multivariate logistic regression mode. Success and failure were determined by the normalization of the hip based on the Graf hip classification.

RESULTS

The failure rate of patients treated with Pavlik harness was 16.6% which is within the reported range of failure rate. The mean age of patients who were successfully treated was 6.73 weeks in comparison to 8.84 weeks for those who failed. Age, plagiocephaly, hip instability, Graf classification, and the development of femoral nerve palsy were found to be predictors for failure of PH treatment upon univariate analysis only. However, only the presence of Galeazzi sign, hip instability, high grades of Graf hip classification, and the development of femoral nerve palsy proved to be independent predictors for failed PH treatment upon multivariate logistic regression analysis.

CONCLUSIONS

Pavlik harness treatment is a successful treatment with an average success of 83.4%. Several independent predictors for failure of PH treatment have been identified. These include a positive Galeazzi sign, a frankly dislocated hip, Graf types III and IV, and the development of femoral nerve palsy.

Vojta method in the treatment of developmental hip dysplasia - a case report

Background

Developmental dysplasia of the hip joint is one of the most common congenital defects and often results in functional and structural disorders. Such cases particularly demand optimizing therapeutic effects and maximally reducing the duration of therapy.

Purpose

The aim of this case report is to present the therapeutic process in a child with developmental hip dysplasia.

Case report

This is a case report of a female child with a birth weight of 2,800 g and an Apgar score of 9 points born to a gravida 3 para 3 mother at 37 weeks. The child was delivered by cesarean section, and the pregnancy was complicated by oligohydramnios. Subluxation of the left hip joint was diagnosed by an orthopedist in the third month of life. The treatment followed was the Vojta method (the first phase of reflex turning and reflex crawling).

Results

During the 6 weeks of the Vojta treatment, the left half of the femoral head was centralized, and the process of formation of the hip joint acetabulum was influenced effectively enough to change the acetabulum’s Graff type from the baseline D to IIb after 41 days of treatment.

Conclusion

The diagnostic work-up of congenital hip joint dysplasia should involve a physiotherapist who will investigate the child’s neuromuscular coordination, in addition to a neonatologist and a pediatrician. The therapy for a disorder of hip joint development of neuromotor origin should involve the application of global patterns according to Vojta. Children with congenital dysplasia of the hip joint should commence rehabilitation as early as possible.

4D-analysis of early pelvic girdle development in the mouse (Mus musculus)

The formation of limb girdles is a key-novelty in vertebrate evolution. Although the knowledge of pattern formation, genetic, and molecular analysis of limb development has prodigiously grown over the past four decades, the morphogenesis of the pelvic element, joining the appendicular with the axial skeleton has poorly been investigated. Because of their heterochrony in development and evolution, axial and appendicular skeletal elements have seldom been seen as a cojoined morphological complex. The present study examines the pelvis morphogenesis in the mouse (Mus musculus), with special focuses on the axio-appendicular linkage, the formation and number of elements, and the joint formation. Serial histological sections of specimens from Theiler stages (TH) 18-25 (Theiler, 1972) were examined using bright field microscopy. 3D-models of the growing pelvis were reconstructed from these serial sections. The generated 3D-models were subsequently integrated into a computer-animated 4D-visualization illustrating the complex developmental dynamics of the mammalian pelvis morphogenesis. The findings demonstrate that the pelvic element forms from a single mesenchymal condensation in close vicinity to the appendicular skeleton. From the early start of development the pelvic element is limb-associated, and quite lately connects to the axial skeleton. Additionally, the 4D-visualization of the entire developmental process reveals a yet unnoticed reorientation of the mouse pelvic element from an initial posteriorly oblique developmental position to a ventrally oblique definitive position.