Hip Disorders In Children Research Articles

Management of Hip Disorders in Children

This 284-page, multiauthored book states as its avowed purpose, an approach to designing surgical and nonsurgical treatment programs for individual patients based on the pathophysiologic nature of their specific orthopedic conditions. The reader is prepared for this purpose beginning with the first four chapters on development and growth of the hip, including its vascularity, the femoral growth plate, and patterns of deformity of the developing hip. Succinctly, with clarity and only a little overlap, a fundamental understanding of the child's hip is well presented. The next nine chapters are on fractures, slipped femoral capital epiphysis, infections, congential dislocation of the hip, Legg-Calve-Perthes disease, cerebral palsy, myelomeningocele, arthrogryposis, and congenital abnormalities of the femur. These chapters are uneven in quality, best succeeding when there is a personal experience by the author and not merely a literature review. The last chapter on principles of management is interesting but contributes little in comparison

Hip Disorders in Infants and Children

This potpourri of information on childhood hip disorders is well organized and presented in a very readable fashion. The discussion of hip joint anatomy, growth and development, and biomechanical considerations are well covered in more detail than most medical students, pediatricians, and family practitioners require. The author has done independent research on femoral head blood supply in children and explains why the femoral head is at risk for avascular necrosis. He tells us why shear stress is important and how the perichondrial complex assumes a contributory role in slipped capital femoral epiphysis. There is a brief discussion of the normal and pathologic gait in childhood. There is an excellent review of the physical examination, with diagrams detailing how to do the examinations and with normal values of hip joint motion given in table form. Examination of the newborn, with emphasis on the joint range of motion tests, Barlow's test for

Hip Disorders in Children

Hip Disorders in Children

Hip Disorders in Children

The authors have endeavored to summarize six general categories of disease that plague a child's hip. A seventh category lists miscellaneous afflictions for the sake of completeness. These general categories of hip disease reflect the extensive experience of each of the authors. There is still considerable controversy as to the best treatment; however, the general principles have been established and are well outlined in this book. This is written primarily for the orthopedist and orthopedic resident. Pediatricians will find certain sections in each chapter that deal with etiology, clinical presentation, and expected results valuable for diagnosis and follow-up after treatment. Descriptions are well annotated and there is an excellent current bibliography. The roentgenograms are of adequate quality, which is often hard to obtain. An honest appraisal of the surgical techniques and the follow-up results are adequate. They correctly stressed the importance of avoiding any abnormal joint positions, especially abduction, when

Pinhole imaging in legg-perthes disease: Further observations

Fifty-nine patients with Legg-Perthes disease and 12 others were studied using 99mTc-polyphosphate and the pinhole collimator imaging technique. Radiographs of both hips were correlated with images in each patient. In the Legg-Perthes patients, a radionuclide uptake deficiency of variable size was observed in the proximal femoral epiphysis (EOC), which we believe is related to varying degrees of impaired blood supply. During later disease stages, adjacent zones of increased radionuclide activity of revascularization were observed that would replace the uptake defect eventually. Unless radiographic evidence of new bone formation was observed in the EOC, it was impossible to predict either the presence or extent of revascularization until bone imaging was done. Those patients with revascularization activity in the EOC exhibited a relatively short time interval (average, 3.2 months) before evidence of new bone formation radiographically. Others with increased radionuclide concentration limited to the growth plate and/or metaphysis averaged a much longer 7.8 months. In two patients there was a reversal of the initially increased activity in the growth plate, suggesting another vascular insult. There were no false-negative bone-image findings in the 12 cases that clinically and/or radiologically simulated Legg-Perthes disease. Our image studies correlate well with published histopathologic investigations, indicating to us that assessment of extent of pathologic involvement and of the disease course is facilitated by this technique. Subsequently, this could influence treatment selection and provide a more objective baseline from which to judge treatment results. Continued experience suggests pinhole bone imaging has useful clinical application in Legg-Perthes disease and other childhood hip disorders.

99m-to-polyphosphate bone imaging in Legg-Perthes disease.

99m-Tc--polyphosphate bone imaging was useful in distinguishing Legg-Perthes disease from other childhood hip disorders in 40 patients. In 33 Legg-Perthes patients, imaging provided earlier and more accurate information concerning the extent of the necrotic and revascularization process involving the hip than radiographs alone. This advantage could both facilitate treatment selection and provide a more objective baseline from which to judge treatment results. Preliminary experience also suggests that the technique may offer some insight into the pathogenesis of Legg-Perthes disease.