Achilles tendon diseases and its management

Abstract

Objectives: We evaluated the results of treatment in patients who were treated according to an algorithm established for developmental dysplasia of the hip (DDH) during the first 18 months of life. Methods: We developed an algorithm for DDH to be used in infants at 0 to 18 months of age. Patients who did not respond to, or who did not have the indication for, the use of Pavlik harness were treated according to our algorithm and evaluated prospectively. Thirty-three hips (24 patients; 21 girls, 3 boys; mean age 7.4 months; range 2.5 to 18 months) were followed-up for a mean of 42 months (range 15 to 90 months). Ultrasonographic evaluation was performed using the Graf method. Avascular necrosis was evaluated according to the Kalamchi and MacEwen classification, and radiological results according to the Severin classification. Results: The mean acetabular index angles before and after treatment were 37.3° (range 20 to 58°) and 21.8° (range 15° to 30°), respectively. According to the Kalamchi and MacEwen classification, six hips (18.2%) had type I, three hips (9.1%) had type II, and one hip (3%) had type III avascular necrosis. According to the Severin criteria, 21 hips were considered in group I, 10 in group II, and two hips in group III. Acetabular osteotomies were performed in four hips. All patients had full range of motion without any pain and limp. Conclusion: Successful clinical results obtained in the hips treated according to this algorithm for DDH may serve to justify its use as a standard algorithm in the treatment of infants at ages 0 to 18 months.