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Risk factors for avascular necrosis after closed reduction for developmental dysplasia of the hip

PURPOSE: The purpose of this study was to identify and evaluate risk factors of avascular necrosis (AVN) after closed treatment for developmental dysplasia of the hip (DDH). METHODS: A retrospective review of children diagnosed with DDH at a tertiary-care children’s hospital between 1986 and 2009 wa...

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Autores principales: Schur, Mathew D., Lee, Christopher, Arkader, Alexandre, Catalano, Anthony, Choi, Paul D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909658/
https://www.ncbi.nlm.nih.gov/pubmed/27177477
http://dx.doi.org/10.1007/s11832-016-0743-7
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author Schur, Mathew D.
Lee, Christopher
Arkader, Alexandre
Catalano, Anthony
Choi, Paul D.
author_facet Schur, Mathew D.
Lee, Christopher
Arkader, Alexandre
Catalano, Anthony
Choi, Paul D.
author_sort Schur, Mathew D.
collection PubMed
description PURPOSE: The purpose of this study was to identify and evaluate risk factors of avascular necrosis (AVN) after closed treatment for developmental dysplasia of the hip (DDH). METHODS: A retrospective review of children diagnosed with DDH at a tertiary-care children’s hospital between 1986 and 2009 was performed. The presence of AVN was assessed according to Salter’s classification system. RESULTS: Eighty-two affected hips in 70 children with an average age of 10 months at closed reduction (range 1–31 months) and 5 years (range 2–19 years) of follow-up met the inclusion criteria. Twenty-nine (of 82, 35 %) affected hips developed AVN. The use of pre-reduction traction (p = 0.019) increased the risk of AVN, while preoperative Pavlik harness or brace trial (p = 0.28), presence of ossific nucleus at the time of closed reduction (p = 0.16), and adductor tenotomy (p = 0.37) were not significant factors. Laterality (right vs. left) was also not a significant risk factor (p = 0.75), but patients who underwent closed reduction for bilateral DDH were less likely to develop AVN (p = 0.027). Overall, the degree of abduction did not affect the rate of AVN (p = 0.87). However, in patients treated with closed reduction younger than 6 months of age, the rate of AVN was increased with abduction ≥50° (9/15, 60 %) compared to abduction <50° (0/8, 0 %) (p = 0.007). Patients who developed AVN were more likely to require subsequent surgery (p = 0.034) and more likely to report a fair/poor clinical outcome (p = 0.049). CONCLUSIONS: The risk of AVN (35 %) following closed reduction and spica casting for DDH is high. The degree of abduction in spica casts appears to be a risk factor in patients ≤6 months old. The authors recommend that abduction in spica casts should be limited to <50° in children younger than 6 months of age. LEVEL OF EVIDENCE: IV.
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spelling pubmed-49096582016-07-01 Risk factors for avascular necrosis after closed reduction for developmental dysplasia of the hip Schur, Mathew D. Lee, Christopher Arkader, Alexandre Catalano, Anthony Choi, Paul D. J Child Orthop Original Clinical Article PURPOSE: The purpose of this study was to identify and evaluate risk factors of avascular necrosis (AVN) after closed treatment for developmental dysplasia of the hip (DDH). METHODS: A retrospective review of children diagnosed with DDH at a tertiary-care children’s hospital between 1986 and 2009 was performed. The presence of AVN was assessed according to Salter’s classification system. RESULTS: Eighty-two affected hips in 70 children with an average age of 10 months at closed reduction (range 1–31 months) and 5 years (range 2–19 years) of follow-up met the inclusion criteria. Twenty-nine (of 82, 35 %) affected hips developed AVN. The use of pre-reduction traction (p = 0.019) increased the risk of AVN, while preoperative Pavlik harness or brace trial (p = 0.28), presence of ossific nucleus at the time of closed reduction (p = 0.16), and adductor tenotomy (p = 0.37) were not significant factors. Laterality (right vs. left) was also not a significant risk factor (p = 0.75), but patients who underwent closed reduction for bilateral DDH were less likely to develop AVN (p = 0.027). Overall, the degree of abduction did not affect the rate of AVN (p = 0.87). However, in patients treated with closed reduction younger than 6 months of age, the rate of AVN was increased with abduction ≥50° (9/15, 60 %) compared to abduction <50° (0/8, 0 %) (p = 0.007). Patients who developed AVN were more likely to require subsequent surgery (p = 0.034) and more likely to report a fair/poor clinical outcome (p = 0.049). CONCLUSIONS: The risk of AVN (35 %) following closed reduction and spica casting for DDH is high. The degree of abduction in spica casts appears to be a risk factor in patients ≤6 months old. The authors recommend that abduction in spica casts should be limited to <50° in children younger than 6 months of age. LEVEL OF EVIDENCE: IV. Springer Berlin Heidelberg 2016-05-13 2016-06 /pmc/articles/PMC4909658/ /pubmed/27177477 http://dx.doi.org/10.1007/s11832-016-0743-7 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Clinical Article
Schur, Mathew D.
Lee, Christopher
Arkader, Alexandre
Catalano, Anthony
Choi, Paul D.
Risk factors for avascular necrosis after closed reduction for developmental dysplasia of the hip
title Risk factors for avascular necrosis after closed reduction for developmental dysplasia of the hip
title_full Risk factors for avascular necrosis after closed reduction for developmental dysplasia of the hip
title_fullStr Risk factors for avascular necrosis after closed reduction for developmental dysplasia of the hip
title_full_unstemmed Risk factors for avascular necrosis after closed reduction for developmental dysplasia of the hip
title_short Risk factors for avascular necrosis after closed reduction for developmental dysplasia of the hip
title_sort risk factors for avascular necrosis after closed reduction for developmental dysplasia of the hip
topic Original Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909658/
https://www.ncbi.nlm.nih.gov/pubmed/27177477
http://dx.doi.org/10.1007/s11832-016-0743-7
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