VanderHave, Kelly L; Raab, Gregory E
Purpose of review:
To critique the literature over the past year and emphasize advances made that may influence the management of pediatric hip disorders in the future.
The Plastizote abduction orthosis is a reasonable alternative to the more traditional Pavlik harness in the management of dislocatable or dislocated but reducible hips in neonates. The success of this device is attributed to moderate abduction and ease of use and acceptance by the parents. The importance of an ossific nucleus before reduction of developmental dysplasia of the hip continues to be debated. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage, designed to specifically examine glycosaminoglycan changes in articular cartilage, could provide a valuable means of monitoring the status of articular cartilage and predict the progression of hip arthrosis. A review found that the optimal time for containment surgery for Perthes disease is during the stage of sclerosis or early fragmentation. Soft tissue release combined with unloading of the femoral head with distraction may improve function in patients with late-onset Perthes disease. The morbidity of pelvic osteomyelitis has increased over the past decade, perhaps because of the increased virulence of offending organisms. The development of clinical practice guidelines has been a major emphasis of the movement toward evidence-based medicine. A standardized management process for specific clinical conditions such as septic arthritis may improve the process of care and clinical outcomes. The use of a trochanteric starting point has proved to be a safe alternative for the management of femoral shaft fractures in skeletally immature adolescents.
The articles in this review were selected for clinical relevance, quality, and controversy. This review looks specifically at studies that address the prevention, diagnosis, and treatment of the most common pediatric hip disorders.
Current Opinion in Orthopedics. 15(6):411-416, December 2004.