Specialty Update   |    
What's New in Pediatric Orthopaedics
Kenneth J. Noonan, MD1; Ira Zaltz, MD1; Dennis Wenger, MD2
1 University of Wisconsin School of Medicine and Public Health, Health Sciences Learning Center, 750 Highland Avenue, Madison, WI 53705. E-mail address for K.J. Noonan: noonan@orthorehab.wisc.edu
2 Pediatric Orthopedic and Scoliosis Center, 3030 Children's Way, Suite 410, San Diego, CA 92123. E-mail address: orthoedu@rchsd.org
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Specialty Update has been developed in collaboration with the Board of Specialty Societies (BOS) of the American Academy of Orthopaedic Surgeons.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Mar 16;93(6):597-606. doi: 10.2106/JBJS.J.01693
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A prospective randomized trial evaluating immediate treatment compared with active sonographic surveillance for infants with dysplastic, nondislocatable hips demonstrated that surveillance halved the need for treatment without having an effect on the radiographic appearance of the hip at the age of one year1. In a study in which twenty-nine patients with bilateral dislocation of the hip were compared with thirty-eight patients with unilateral dislocation, there was no significant difference between the two groups with regard to the failure of Pavlik treatment2. Two studies analyzed factors associated with unsuccessful Pavlik harness treatment of dislocated hips3,4. In one series of 221 hips, successful reduction was obtained in 81.9% of the hips, with development of osteonecrosis in 8.8%3. Adduction contracture and decreased distance from the proximal medial femoral metaphysis (indicated by the "a" line) were identified as risk factors that were predictive of failure. Another study of eighty-five patients demonstrated a rate of Pavlik harness failure of 37%4. Sonographic findings associated with unsuccessful Pavlik harness treatment included an increased beta angle, superior femoral head migration relative to the labrum, and total femoral head displacement less than -30°4. In a retrospective review of late-presenting patients (age range, six to twenty-four months) who were managed with Pavlik harness reduction, 60% of Graf type-3 hips were reduced with no associated osteonecrosis, whereas no Graf type-4 hips were reduced5.
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