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Cummings JL, Oladeji AK, Rosenfeld S, Johnson M, Goldstein R, Georgopoulos G, Stephenson L, White NW, Hosseinzadeh P. Severity of hip dysplasia as the major factor affecting outcome of closed reduction in children with hip dysplasia. J Pediatr Orthop B 2023:01202412-990000000-00147. [PMID: 37669157 DOI: 10.1097/bpb.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
The objective of this study was to analyze a multicenter cohort of children with developmental dysplasia of the hip (DDH) who underwent treatment with closed reduction. We sought to report the effects that severity of hip dysplasia and age have on the development of femoral head avascular necrosis (AVN) and the need for additional procedures. All patients with DDH and minimum 2 years of follow-up who underwent closed reduction were identified. The following variables were recorded: sex, laterality of hip involvement, age, acetabular index (AI), and International Hip Dysplasia Institute (IHDI) grade. The effects of patient age and pre-procedure IHDI grade on the rate of AVN and need for additional procedures after the closed reduction were analyzed using an alpha of 0.05. Seventy-eight total hips were included in the final analysis. The average patient age was 12 months. AVN of the femoral head was reported in 24 hips (30.8%) and 32 hips (41.0%) required additional surgery. Higher pre-op IHDI grade was associated with higher risk of developing Bucholz-Ogden grades II-IV AVN of the femoral head (P = 0.025) and requiring additional surgery (P= 0.033) regardless of patient age. There were no statistically significant differences for the effect of age on the measured outcomes (P > 0.05). These findings suggest that severity of dislocation (IHDI grade) is a significant risk factor for the development of AVN and need for additional procedure.
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Affiliation(s)
- Jason L Cummings
- Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, Missouri
| | - Afolayan K Oladeji
- Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, Missouri
| | | | - Megan Johnson
- Vanderbilt Children's Hospital, Nashville, Tennessee
| | | | | | | | - Nathan W White
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Pooya Hosseinzadeh
- Department of Orthopedic Surgery, Washington University in St. Louis, Saint Louis, Missouri
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Fu Z, Zhang Z, Deng S, Yang J, Li B, Zhang H, Liu J. MRI assessment of femoral head docking following closed reduction of developmental dysplasia of the hip. Bone Joint J 2023; 105-B:140-147. [PMID: 36722051 PMCID: PMC9869706 DOI: 10.1302/0301-620x.105b2.bjj-2022-0547.r2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS Eccentric reductions may become concentric through femoral head 'docking' (FHD) following closed reduction (CR) for developmental dysplasia of the hip (DDH). However, changes regarding position and morphology through FHD are not well understood. We aimed to assess these changes using serial MRI. METHODS We reviewed 103 patients with DDH successfully treated by CR and spica casting in a single institution between January 2016 and December 2020. MRI was routinely performed immediately after CR and at the end of each cast. Using MRI, we described the labrum-acetabular cartilage complex (LACC) morphology, and measured the femoral head to triradiate cartilage distance (FTD) on the midcoronal section. A total of 13 hips with initial complete reduction (i.e. FTD < 1 mm) and ten hips with incomplete MRI follow-up were excluded. A total of 86 patients (92 hips) with a FTD > 1 mm were included in the analysis. RESULTS At the end of the first cast period, 73 hips (79.3%) had a FTD < 1 mm. Multiple regression analysis showed that FTD (p = 0.011) and immobilization duration (p = 0.028) were associated with complete reduction. At the end of the second cast period, all 92 hips achieved complete reduction. The LACC on initial MRI was inverted in 69 hips (75.0%), partly inverted in 16 hips (17.4%), and everted in seven hips (7.6%). The LACC became everted-congruent in 45 hips (48.9%) and 92 hips (100%) at the end of the first and second cast period, respectively. However, a residual inverted labrum was present in 50/85 hips (58.8%) with an initial inverted or partly inverted LACC. CONCLUSION An eccentric reduction can become concentric after complete reduction and LACC remodelling following CR for DDH. Varying immobilization durations were required for achieving complete reduction. A residual inverted labrum was present in more than half of all hips after LACC remodelling.Cite this article: Bone Joint J 2023;105-B(2):140-147.
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Affiliation(s)
- Zhe Fu
- Department of Pediatric Orthopedics, Tianjin Hospital, Tianjin, China
| | - Zhongli Zhang
- Department of Pediatric Orthopedics, Tianjin Hospital, Tianjin, China
| | - Shuzhen Deng
- Department of Pediatric Orthopedics, Tianjin Hospital, Tianjin, China
| | - Jianping Yang
- Department of Pediatric Orthopedics, Tianjin Hospital, Tianjin, China
| | - Bing Li
- Department of Joint, Tianjin Hospital, Tianjin, China
| | - Huadong Zhang
- Department of Pediatric Orthopedics, Tianjin Hospital, Tianjin, China
| | - Jun Liu
- Department of Joint, Tianjin Hospital, Tianjin, China,Correspondence should be sent to Jun Liu. E-mail:
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Gangaram-Panday SSG, de Vos-Jakobs S, Reijman M. The Effect of Traction before Closed Reduction in Patients with Developmental Dysplasia of the Hip. CHILDREN 2022; 9:children9091325. [PMID: 36138634 PMCID: PMC9497839 DOI: 10.3390/children9091325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022]
Abstract
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.
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Ma S, Zhou W, Li L, Wang E, Zhang L, Li Q. Retrospective Comparison of Outcomes Between Closed and Open Reduction for Developmental Dysplasia of the Hip in Children Aged 6-24 Months. Indian J Orthop 2022; 56:1640-1646. [PMID: 36052390 PMCID: PMC9385909 DOI: 10.1007/s43465-022-00690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE We aimed to compare the outcomes between closed reduction (CR) and open reduction (OR) in children aged 6-24 months with developmental dysplasia of the hip (DDH) who could be reduced safely and stably by the closed reduction operation. METHODS We retrospectively reviewed the medical records of 77 patients who underwent CR or OR for DDH. Fifty-one patients (56 hips) underwent CR, 26 (29 hips) underwent OR. The demographic data, International Hip Dysplasia Institute classification and acetabular index (AI) before reduction and the centre-edge angle (CEA), AI, Alsberg angle (AA), Reimer's migration index (RMI), and height-to-width index (HWI) of the epiphysis were compared between two groups at the final follow-up. The percentage of coxa magna > 15% of the normal side and AA > 81° were calculated. RESULTS At the final follow-up, the mean AA in the CR and OR groups were 77.66° (60°-89°) and 81.97° (73°-91°) (p = 0.001), respectively, there were 32.14% and 58.62% of the hips with an AA > 81° (p = 0.019). The frequency of coxa magna > 15% of the normal side was higher in the OR group (60.9%) than in the CR group (6.5%) (p < 0.001). There was no difference in the improvement of AI, CEA, HWI, and RMI. CONCLUSION In children aged 6-24 months with DDH, if a stable and safe CR can be obtained but with medial joint space up to 6mm, CR should be attempted first.
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Affiliation(s)
- Shuyu Ma
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Weizheng Zhou
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Enbo Wang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Lijun Zhang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Qiwei Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, 110004 China
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Liu J, Zhou W, Li L, Zhang L, Li Q, Wang E. The fate of inverted limbus in children with developmental dysplasia of the hip: Clinical observation. J Orthop Res 2021; 39:1433-1440. [PMID: 32946117 DOI: 10.1002/jor.24864] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/19/2020] [Accepted: 08/31/2020] [Indexed: 02/04/2023]
Abstract
In this study, we observed the fate of the inverted limbus after closed reduction for the treatment of developmental dysplasia of the hip (DDH) and its impact on acetabular development. Clinical data were reviewed for 26 DDH patients with an inverted or overriding limbus after closed reduction for hip dysplasia. Patients were divided into a residual inversion group (19 cases, 22 hips) and a spontaneous resolution group (7 cases, 7 hips) according to the limbus status at the last follow-up. Differences in the osseous acetabular index (AI) and cartilaginous AI (CAI), the magnitude of limbus inversion, center-edge angle (CEA), height-to-width index (HWI) of the femoral head epiphysis, and avascular necrosis (AVN) at last follow-up were compared. There were no statistically significant differences in the preoperative AI and CAI between groups. The magnitude of limbus inversion after reduction and the AI at the final follow-up in the residual inversion group were both larger than those in the spontaneous resolution group. The CAI, CEA, and HWI were not significantly different between groups. The magnitude of limbus inversion in the residual inversion group did not significantly decrease over time. AVN occurred in five hips in the residual inversion group. No cases of AVN occurred in the spontaneous resolution group. After closed reduction, the inverted limbus was not absorbed in the majority of cases; instead, it evolved into a thin layer of fibrous tissue embedded between the femoral head and acetabulum. This may delay the endochondral ossification of the acetabulum.
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Affiliation(s)
- Jiahui Liu
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weizheng Zhou
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lijun Zhang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiwei Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Enbo Wang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China
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Hussain RN, Rad D, Watkins WJ, Carpenter C. The incidence of avascular necrosis following a cohort of treated developmental dysplasia of the hip in a single tertiary centre. J Child Orthop 2021; 15:232-240. [PMID: 34211599 PMCID: PMC8223083 DOI: 10.1302/1863-2548.15.200246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Avascular necrosis (AVN) may occur following treatment for developmental dysplasia of the hip (DDH). The primary aim of this study was to identify the incidence of AVN in a cohort of patients treated for DDH. Secondary aims were to classify AVN using available classification systems, analyze the correlation between the systems and investigate their relationship with the age at diagnosis of DDH. METHODS An 11-year retrospective study was carried out at a single tertiary centre, using data from the clinical portal (patient records database) and IMPAX (system used to store plain radiographic images). Clinical details (patient demographics and outcomes) and plain radiographic images were used to identify cases of DDH and categorize cases of AVN using available classification systems: Tonnis and Kuhlmann, Kalamchi and McEwen, Bucholz and Ogden and Salter. Severin was used to assess final clinical outcome. RESULTS In total, 405 (522 hips) cases of DDH were identified, of which 213 resolved without treatment, 93 were treated conservatively and 99 surgically. Only treated cases were included in the analysis (n = 192). AVN (45/99; 45.5%) was found to occur only postoperatively. A positive correlation was present between age at presentation and severity of AVN as classified according to Salter's criteria (chi-squared p value < 0.01). CONCLUSION AVN incidence was 23.4% (45/192) and only occurred in surgically treated patients. Older age at diagnosis was associated with a higher incidence of AVN, as defined according to Salter's criteria. The classification systems appeared to show no correlation amongst each other (p-value < 0.01). LEVEL OF EVIDENCE III - Retrospective cohort study.
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Affiliation(s)
- Rahim Nawaz Hussain
- University Hospital of Wales, Cardiff, UK,Correspondence should be sent to: Dr. Rahim Nawaz Hussain, Worcestershire Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD, United Kingdom. E-mail:
| | - Darius Rad
- Children’s Hospital for Wales, University Hospital of Wales, Cardiff, UK
| | | | - Clare Carpenter
- Children’s Hospital for Wales, University Hospital of Wales, Cardiff, UK
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Zhang G, Li M, Qu X, Cao Y, Liu X, Luo C, Zhang Y. Efficacy of closed reduction for developmental dysplasia of the hip: midterm outcomes and risk factors associated with treatment failure and avascular necrosis. J Orthop Surg Res 2020; 15:579. [PMID: 33267908 PMCID: PMC7709328 DOI: 10.1186/s13018-020-02098-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the efficacy of closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) and to investigate risk factors associated with CR failure and avascular necrosis (AVN) occurrence in follow-ups. METHODS The study retrospectively included 110 patients and 138 hips with DDH diagnosis that underwent closed reduction between February 2012 and November 2015 in our single tertiary medical institution. The failure rate of CR and the underlying risk factors were evaluated. Meanwhile, the incidence of AVN and the related risk factors among the successful CR cases were assessed. RESULTS The overall failure rate of DDH treated by CR in the present study was 31.16% (43/138). Risk factors for the CR failure were older age at the time of CR (≥ 18.35 month), large medical interval before CR (≥ 35.35 mm), and severer dislocation of the affected hip (IDHI grades III and IV). The incidence of AVN was 8.33% (6/72) in patients with successful CR at the last follow-up. No significant risk factors had been established in the present study that associated with the AVN occurrence. CONCLUSIONS For the treatment of DDH with CR, patients with younger age might achieve better outcomes; early diagnosis and early treatment might be the key point in the DDH treatment.
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Affiliation(s)
- Ge Zhang
- Department of Orthopaedics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Ming Li
- Department of Orthopaedics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Xiangyang Qu
- Department of Orthopaedics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Yujiang Cao
- Department of Orthopaedics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Xing Liu
- Department of Orthopaedics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Cong Luo
- Department of Orthopaedics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Yuan Zhang
- Department of Orthopaedics; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation base of Child development and Critical Disorders; Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yuzhong District, Chongqing, 400014, People's Republic of China.
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Terjesen T, Horn J. Management of late-detected DDH in children under three years of age: 49 children with follow-up to skeletal maturity. Bone Jt Open 2020; 1:55-63. [PMID: 33215108 PMCID: PMC7659678 DOI: 10.1302/2633-1462.14.bjo-2019-0005.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Aims When the present study was initiated, we changed the treatment for late-detected developmental dislocation of the hip (DDH) from several weeks of skin traction to markedly shorter traction time. The aim of this prospective study was to evaluate this change, with special emphasis on the rate of stable closed reduction according to patient age, the development of the acetabulum, and the outcome at skeletal maturity. Methods From 1996 to 2005, 49 children (52 hips) were treated for late-detected DDH. Their mean age was 13.3 months (3 to 33) at reduction. Prereduction skin traction was used for a mean of 11 days (0 to 27). Gentle closed reduction under general anaesthesia was attempted in all the hips. Concurrent pelvic osteotomy was not performed. The hips were evaluated at one, three and five years after reduction, at age eight to ten years, and at skeletal maturity. Mean age at the last follow-up was 15.7 years (13 to 21). Results Stable closed reduction was obtained in 36 hips (69%). Open reduction was more often necessary in patients ≥ 18 months of age at reduction (50%) compared with those under 18 months (24%). Residual hip dysplasia/subluxation occurred in 12 hips and was significantly associated with avascular necrosis (AVN) and with high acetabular index and low femoral head coverage the first years after reduction. Further surgery, mostly pelvic and femoral osteotomies to correct subluxation, was performed in eight hips (15%). The radiological outcome at skeletal maturity was satisfactory (Severin grades 1 or 2) in 43 hips (83%). Conclusions Gentle closed reduction can be attempted in children up to three years of age, but is likely to be less successful in children aged over 18 months. There is a marked trend to spontaneous improvement of the acetabulum after reduction, even in patients aged over 18 months and therefore simultaneous pelvic osteotomy is not always necessary.
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Affiliation(s)
- Terje Terjesen
- Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway
| | - Joachim Horn
- Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway
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Surgical management of the congenital dislocation of the knee and hip in children presented after six months of age. INTERNATIONAL ORTHOPAEDICS 2020; 44:2635-2644. [PMID: 32772317 PMCID: PMC7679307 DOI: 10.1007/s00264-020-04759-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/28/2020] [Indexed: 10/28/2022]
Abstract
PURPOSE Congenital dislocation of the knee and hip is a rare congenital disorder. The specific aim of the study was to evaluate the clinical and radiological outcomes of the children with congenital dislocation of the knee and hip who presented after six months of age. METHODS All the consecutive children with congenital dislocation of the knee and hip joints were retrospectively reviewed. We included cases that were treated after six months of age and followed up for a minimum of two years. Twenty-four children with congenital dislocation of the knee and hip (thirteen with ligamentous laxity, eleven children with stiff joints) were included. The knee was dislocated in 45 limbs; the hip was dislocated in 40 instances. The knee joint dislocation was treated with quadricepsplasty in all twenty-four children (45 knees). The hip dislocation (n = 32) was addressed with either closed reduction (n = 8) or open reduction of the hip (n = 24). Eight hip dislocations were not addressed. The outcome of the hip and knee was evaluated. RESULTS The clinical and radiological outcomes were better in children with ligamentous laxity than without laxity. Twenty-two children were community walkers. An orthosis was needed in eight children. The frequency of spontaneous reduction of unreduced dislocation of the hip was noted in three children (5/8 hips). CONCLUSION Outcome in combined dislocation of knee and hip is good in most cases with surgical interventions. The outcome is better in children with ligamentous laxity. Spontaneous reduction of the dislocated hips might be achieved after gaining knee flexion following knee surgery for congenital the knee in a few cases.
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Walter SG, Endler CHJ, Remig AC, Luetkens JA, Bornemann R, Placzek R. Risk factors for failed closed reduction in dislocated developmental dysplastic hips. INTERNATIONAL ORTHOPAEDICS 2020; 44:2343-2348. [PMID: 32488566 PMCID: PMC8275556 DOI: 10.1007/s00264-020-04655-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022]
Abstract
AIM OF THE STUDY The present study aimed to identify risk factors for unsuccessful CR. INTRODUCTION Closed reduction (CR) represents the gold standard for treatment of developmental dysplasia of the hip (DDH), but to a minor percentage, it fails to reduce dysplastic hips successfully. METHODS Seventy-three dysplastic hips underwent closed reduction and post-interventional MRI of the pelvis. MRIs were evaluated for successful reduction of the hip, volumes of femoral heads, and acetabular diameter. Initial treatment results were correlated to AC angles at two years of follow-up. Contralateral, healthy hips served as control. RESULTS Out of 73 instable, dysplastic hips, there were nine cases of CR failure. These cases showed significantly increased femoral head volumes (p = 0.002) and a significantly (p = 0.02) larger ratio of femoral head volume to acetabular opening area. There was no significant difference (p = 0.15) in acetabular diameter between both groups. At two years of follow-up, AC angles were significantly (p = 0.003) larger and pathologic in cases of CR failure. CONCLUSION Exclusive enlargement of the femoral head is a risk factor for unsuccessful reduction and its ratio to the acetabular opening surface is predictive for CR success in DDH.
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Affiliation(s)
- Sebastian Gottfried Walter
- Department of Orthopaedic Surgery, University Hospital Bonn, Bonn, Germany.
- Department of Cardiothoracic Surgery, University Hospital Cologne, Kerpener Str. 63, 50937, Cologne, Germany.
| | | | | | | | - Rahel Bornemann
- Department of Orthopaedic Surgery, University Hospital Bonn, Bonn, Germany
| | - Richard Placzek
- Department of Orthopaedic Surgery, University Hospital Bonn, Bonn, Germany
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Jia G, Wang E, Lian P, Liu T, Zhao S, Zhao Q. Anterior approach with mini-bikini incision in open reduction in infants with developmental dysplasia of the hip. J Orthop Surg Res 2020; 15:180. [PMID: 32434526 PMCID: PMC7238660 DOI: 10.1186/s13018-020-01700-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/06/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose The anterior and medial approaches in open reduction for developmental dysplasia of the hip (DDH) had been widely used. The former could not directly approach the intra-articular interposition, while the latter had been associated with injury to blood vessel and avascular necrosis (AVN) of the femoral head. Meanwhile, the bikini incision had also been mentioned in some studies. The purpose of this study was to introduce a modified anterior approach through a mini-bikini incision and report its short-term outcomes. Methods Data of DDH patients younger than 2 years at the time of surgery who had received this mini-bikini incision between June 2013 and December 2018 were collected. The surgical technique, operation duration, intraoperative blood loss, and length of incision were recorded in detail. In the latest follow up, the objective measurement of the scar and the subjective feeling towards the scar were collected. X-ray and magnetic resonance imaging (MRI) were performed at the last follow-up, and the incidence of residual dysplasia, redislocation, and femoral head AVN was analyzed. Results Forty-three cases (49 hips) were included with an averaged follow-up of 43 months. The operation duration was 22 min, and the blood loss was 9.8 ml on average. The length of the scar averaged 2.6 cm. The mean University of North Carolina “4P” scar scale (UNC4P) for the scar was 0.92, and no patients complained numbness. Overall, all the parents were satisfied with the cosmetic appearance. The mean acetabular index (AI) was 27.42° ± 6.41° in dislocated hip in the last follow-up. One hip redislocated soon after the operation and was reduced in a closed manner right away. MRI showed improved coverage but still some residual dysplasia that was in accordance with the post-operative recovery nature. Four hips (8%) had signs of AVN in X-ray. Conclusion Open reduction through the anterior approach with the mini-bikini incision was a safe procedure with comparable outcomes to classical approaches. It would be a complementary approach for DDH patients younger than 2 years old who need an open reduction.
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Affiliation(s)
- Guoqiang Jia
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, China.,Department of Orthopedics, Anhui Provincial Children's Hospital, Hefei, China
| | - Enbo Wang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, China.
| | - Peng Lian
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, China
| | - Tianjing Liu
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, China
| | - Shuyi Zhao
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, China
| | - Qun Zhao
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, China.
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Zhou W, Sankar WN, Zhang F, Li L, Zhang L, Zhao Q. Evolution of concentricity after closed reduction in developmental dysplasia of the hip. Bone Joint J 2020; 102-B:618-626. [PMID: 32349601 DOI: 10.1302/0301-620x.102b5.bjj-2019-1496.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The goal of closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) is to achieve and maintain concentricity of the femoral head in the acetabulum. However, concentric reduction is not immediately attainable in all hips and it remains controversial to what degree a non-concentric reduction is acceptable. This prospective study is aimed at investigating the dynamic evolution of the hip joint space after CR in DDH using MRI. METHODS A consecutive series of patients with DDH who underwent CR since March 2014 were studied. Once the safety and stability were deemed adequate intraoperatively, reduction was accepted regardless of concentricity. Concentricity was defined when the superior joint space (SJS) and medial joint space (MJS) were both less than 2 mm, based on MRI. A total of 30 children, six boys and 24 girls, involving 35 hips, were recruited for the study. The mean age at CR was 13.7 months (3.5 to 27.6) and the mean follow-up was 49.5 months (approximately four years) (37 to 60). The joint space was evaluated along with the interval between the inverted and everted limbus. RESULTS Only three hips (8.6%) were fully concentric immediately after CR. During follow-up, 24 hips (68.6%) and 27 hips (77.1%) became concentric at six months and one year, respectively. Immediate SJS after CR decreased from 3.51 mm to 0.79 mm at six months follow-up (p = 0.001). SJS in the inverted group decreased from 3.75 mm to 0.97 mm at six months follow-up. SJS or MJS in the everted group were less than those in the inverted group at each time of follow-up (p = 0.008, p = 0.002). CONCLUSION A stable, safe but non-concentric reduction achieved before the age of two years appears to improve over time with nearly 80% of hips becoming fully concentric by one year. Cite this article: Bone Joint J 2020;102-B(5):618-626.
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Affiliation(s)
- Weizheng Zhou
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang City, China
| | - Wudbhav N Sankar
- Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Fangfang Zhang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang City, China
| | - Lianyong Li
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang City, China
| | - Lijun Zhang
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang City, China
| | - Qun Zhao
- Department of Pediatric Orthopedics, Shengjing Hospital of China Medical University, Shenyang City, China
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Ucpunar H, Mert M, Camurcu Y, Sofu H, Yildirim T, Bayhan AI. Does Adductor Tenotomy Need During Closed Reduction Have a Prognostic Value in the Treatment of Developmental Dysplasia of the Hip Between 6 and 12 Months of Age? "Adductor Tenotomy in the Treatment of Developmental Dysplasia''. Indian J Orthop 2020; 54:486-494. [PMID: 32549964 PMCID: PMC7270239 DOI: 10.1007/s43465-020-00079-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/24/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adductor tenotomy is needed for clinically complex hips with soft-tissue contractures. It may be proposed that the patients who need adductor tenotomy during closed reduction would have poorer prognosis than the ones without need for adductor tenotomy. The main purposes were to compare the normalization of acetabular index angle (AI), to determine the incidence of femoral head avascular necrosis (AVN), and to predict the need for any secondary surgical intervention between the patients who need adductor tenotomy and those who do not during closed reduction for developmental dysplasia of the hip. MATERIALS AND METHODS The study group consisted of 65 hips treated between 6 and 12 months of age. The mean age at the time of surgery was 8.1 ± 1.4 (6-12) months and the mean follow-up was 4.2 ± 1.5 years. Improvement of AI, rate and severity of AVN, and need for secondary surgery with its predictors were evaluated. RESULTS Adductor tenotomy was performed in 22 hips (Group 1), but not in 43 hips (Group 2). Normalization of the AI was - 14.8° ± 3.5° versus - 14.3° ± 3.2°. The overall incidence of AVN was 18.4%. The rate of secondary surgical intervention was higher in Group 1 (63.1% versus 36.9%) (p = 0.014). CONCLUSIONS No significant difference was detected regarding the improvement of AI as well as the incidence of AVN between the groups. The need for adductor tenotomy during closed reduction was one of the main predictors of the possible secondary surgery.
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Affiliation(s)
- Hanifi Ucpunar
- Department of Orthopedics and Traumatology, Erzincan Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
| | - Muhammed Mert
- University of Health Sciences, Baltalimani Bone Diseases Training and Research Center, Istanbul, Turkey
| | - Yalkin Camurcu
- Department of Orthopedics and Traumatology, Erzincan Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
| | | | - Timur Yildirim
- University of Health Sciences, Baltalimani Bone Diseases Training and Research Center, Istanbul, Turkey
| | - Avni Ilhan Bayhan
- University of Health Sciences, Baltalimani Bone Diseases Training and Research Center, Istanbul, Turkey
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Castañeda PG, Moses MJ. Closed Compared with Open Reduction in Developmentally Dislocated Hips: A Critical Analysis Review. JBJS Rev 2019; 7:e3. [PMID: 31663917 DOI: 10.2106/jbjs.rvw.18.00179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The treatment of developmental dislocation of the hip after walking age continues to be controversial.» Success can be considered in terms of the rates of osteonecrosis or proximal growth disturbance, the rate of recurrent dislocation, and residual dysplasia.» Case series are small and have many confounders.» The rate of residual dysplasia is lowest after an open reduction and pelvic osteotomy.
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Affiliation(s)
- Pablo G Castañeda
- Department of Orthopaedic Surgery, NYU Langone Health and Hassenfeld Children's Hospital, New York University School of Medicine, New York, NY
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MRI reveals unrecognized treatment failures after application of Fettweis plaster in children with unstable hip joints. J Pediatr Orthop B 2019; 28:430-435. [PMID: 30807512 DOI: 10.1097/bpb.0000000000000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
We evaluated the success of treatment of unstable hip joints with the Fettweis plaster followed by MRI to detect potential treatment failures. A total of 132 ultrasound-detected unstable hips of type D, III, or IV according to Graf were treated with closed reduction and Fettweis plaster, followed by MRI. We examined 19 type D, 55 type III, and 58 type IV. Mean age at diagnosis was 84.5 days (SD: ± 55.4). Treatment period was 63.2 days (SD: ± 22.2). In 13 cases, the MRI showed a poor reduction. After repetition of this treatment, all 13 showed a concentric reduction. The use of MRI detects 9.8% of treatment failures. We recommend an MRI examination after each closed reduction to ensure the success of the therapy.
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Bilateral Developmental Dysplasia of the Hip: Does Closed Reduction Have a Role in Management? Outcome of Closed and Open Reduction in 92 Hips. J Pediatr Orthop 2019; 39:e264-e271. [PMID: 30475320 DOI: 10.1097/bpo.0000000000001297] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bilateral developmental dysplasia of the hip (DDH) is believed to have a worse outcome than unilateral DDH with the optimal treatment unclear. To define indications for treatment we report a retrospective series of 92 hips (46 patients) who underwent closed reduction (CR) and/or open reduction (OR). METHODS A total of 58 hips in 29 patients underwent attempted CR using our standardized protocol. In the same 12 year time period, 54 hips in 27 patients underwent an OR. Outcome measures included resolution of acetabular dysplasia, need for further surgery, development of osteonecrosis (ON), and modified Severin Grade. RESULTS CR was successful in 57% of hips; in this group secondary surgery was required in 15% and ON was seen in 12%. In the OR group, 11% failed to stabilize and required further early surgery: ON rate was 15% overall, and secondary surgery was required in 5%. In Tonnis 2/3 hips younger than 2 years, Severin grading was comparable following CR and OR, with 92% and 90% graded as Severin 1, respectively. The rate of significant ON was higher after CR in Tonnis 2/3 hips (12%) than after OR (0%). Overall, Tonnis 4 hips did badly: 94% failed CR and following OR, further surgery for redislocation/residual dysplasia was required in 21%. CONCLUSIONS CR can be successful in Tonnis 2/3 bilateral hips, with acceptable rates of secondary surgery, ON, and Severin grading, the latter equivalent to open reduction. Importantly, persisting with casting of a unilateral dislocation, to allow the contra-lateral hip to stabilize, does not have an adverse effect. CR is not advised in Tonnis 4 bilateral hips. Parents should be counseled that the outcome of surgery for bilateral hips is not as good as for unilateral DDH, particularly for Tonnis 4 hips which are more difficult to stabilize and more likely to require supplementary surgery even after open reduction. LEVEL OF EVIDENCE Level IV-Therapeutic Study.
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Abstract
From 2009 to 2015, 15 infants with a congenital dislocation of the hip were treated with closed reduction under anaesthesia, after first being treated with Pavlik bandaging. A retrospective study was carried out with a minimum follow-up of 1 year to assess the success rate of the procedure and predictive factors. Twelve out of 15 (80%) patients achieved successful reduction. In the successful cases, the Barlow test was positive and the safe zone was 20° or more. In the unsuccessful cases, there was a negative Barlow present in the outpatient clinic and the safe zone was less than 20°. These three cases all had teratologic comorbidity, and required additional surgery in the form of open reduction. Avascular necrosis was noted in one out of 15 (6.7%) patients. In nonteratologic hips, a positive Barlow test with a safe zone of 20° is predictive of a successful closed reduction. In these patients, anaesthesia and arthrography might not be necessary.
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Li Y, Zhou Q, Liu Y, Chen W, Li J, Canavese F, Xu H. Closed reduction and dynamic cast immobilization in patients with developmental dysplasia of the hip between 6 and 24 months of age. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:51-57. [PMID: 30076476 DOI: 10.1007/s00590-018-2289-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/01/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Closed reduction and spica cast is still the preferred treatment option for children presenting with developmental dysplasia of the hip (DDH) after the age of 6 months. This study aims to investigate the outcomes of patients with DDH treated by closed reduction and dynamic cast immobilization. METHODS In total, 159 patients (mean age 15.6 ± 4.2 months; 172 hips) were treated with a dynamic cast immobilization for 3 months, followed by an abduction brace until a stable concentric reduction was achieved. Radiological examination was performed at each follow-up visit to assess reduction, redislocation rate and presence of avascular necrosis (AVN) of the femoral epiphysis. Final radiographic results were evaluated with the Severin classification. RESULTS The redislocation rate was 4.1% (7/172); the overall AVN rate was 14.5% (grade II: 16 hips; grade III: 5 hips; grade IV: 3 hips). At last follow-up visit, the mean age of patients was 61.6 ± 21.3 months (range 30.8-141), and the mean acetabular index was 22.6° ± 5.6°; 67.3% of the hips had Severin type I radiographic criteria, 8.5% had type II, 23.6% had type III, and 0.6% had type IV. CONCLUSIONS Dynamic cast is an alternative to spica cast immobilization in DDH patients undergoing closed reduction. It has similar redislocation and AVN rates compared to standard spica cast immobilization, as reported by previous studies.
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Affiliation(s)
- YiQiang Li
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China
| | - QingHe Zhou
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China
| | - Yuanzhong Liu
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China
| | - WeiDong Chen
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China
| | - JingChun Li
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China
| | - Federico Canavese
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China. .,Pediatric Surgery Department, University Hospital Estaing Clermont Ferrand, 63003, Clermont Ferrand, France.
| | - HongWen Xu
- Department of Pediatric Orthopaedics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China
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Wicart P, Seringe R, Glorion C, Brassac A, Rampal V. Closed reduction in late-detected developmental dysplasia of the hip: indications, results and complications. J Child Orthop 2018; 12:317-322. [PMID: 30154921 PMCID: PMC6090199 DOI: 10.1302/1863-2548.12.180088] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of the study was a review of the literature in order to evaluate the results and complications of closed reduction in late-detected developmental dysplasia of the hip (DDH). METHODS This study consisted of an analysis of the literature relative to late-detected DDH treatment options considering hip congruency, rates of re-dislocation and of avascular necrosis. RESULTS Gradual closed reduction (Petit-Morel method) appears to be an effective method concerning joint congruency restitution. Dislocation relapse and avascular necrosis are more efficiently prevented with closed versus open reduction. The tendency for spontaneous correction of acetabular dysplasia decreases if closed reduction is performed after 18 months of age. Patient age at the beginning of traction should be considered for the prognosis, with a lower rate of satisfactory results showing after the age of 3 years. CONCLUSION In our opinion, the Petit-Morel method is a suitable treatment option for children aged between six months and three years with idiopathic DDH.
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Affiliation(s)
- P. Wicart
- Department of Paediatric Orthopaedic Surgery, Paris Descartes University, Necker/Sick Kid University Hospital, APHP, Paris, France, Correspondenceshould be sent to P. Wicart, Department of Paediatric Orthopaedic Surgery, Paris Descartes University, Necker/Sick Kid University Hospital, APHP, 149 rue de Sèvres, 75015 Paris, France. E-mail:
| | - R. Seringe
- Department of Orthopaedic Surgery, Paris Descartes University, Cochin University Hospital, APHP, Paris, France
| | - C. Glorion
- Department of Paediatric Orthopaedic Surgery, Paris Descartes University, Necker/Sick Kid University Hospital, APHP, Paris, France
| | - A. Brassac
- Department of Paediatric Orthopaedic Surgery, Paris Descartes University, Necker/Sick Kid University Hospital, APHP, Paris, France
| | - V. Rampal
- Department of Pediatric Orthopaedic Surgery, Lenval University Hospital, Nice, France
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Affiliation(s)
- F S Haddad
- NIHR University College London Hospitals Biomedical Research Centre, UK
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