Viktor Bialik

Developmental dysplasia of the hip: a new approach to incidence.

Objective. The controversy over the incidence of developmental dysplasia of the hip (DDH) stems mainly from an ambiguity of criteria for defining a genuinely pathologic neonatal hip. In this study, we evaluate an algorithm we devised for the treatment of DDH, for its ability to identify those neonatal hips which, if left untreated, would develop any kind of dysplasia and, therefore, are to be included in the determination of DDH incidence. Methods. Clinical and ultrasonographic examinations for DDH were performed on 18 060 consecutive neonatal hips at 1 to 3 days of life. Newborns with skeletal deformities, neurologic/muscular disorders, and neural tube defects were excluded. Hips that featured any type of sonographic pathology were reexamined at 2 or 6 weeks, depending on the severity of the findings. Only hips in which the initial pathology was not improved or had deteriorated were treated; all others were examined periodically until the age of 12 months. Results. Sonographic screening of 18 060 hips detected 1001 instances of deviation from normal, indicating a sonographic DDH incidence of 55.1 per 1000. However, only 90 hips remained abnormal and required treatment, indicating a true DDH incidence of 5 per 1000 hips. All the others evolved into normal hips, and no additional instances of DDH were found on follow-up throughout the 12 months. Conclusions. The implementation of our protocol enables us to distinguish two categories of neonatal hip pathology: one that eventually develops into a normal hip (essentially sonographic DDH); and another that will deteriorate into a hip with some kind of dysplasia, including full dislocation (true DDH). This approach seems to allow for a better-founded definition of DDH, for an appropriate determination of its incidence, for decision-making regarding treatment, and for assessment of the cost-effectiveness of screening programs for the early detection of DDH. developmental dysplasia of the hip, incidence, neonatal screening, sonography.

Pyomyositis caused by vigorous exercise in a boy

We report on a 12‐year‐old boy who suffered from staphylococcal pyomyositis in both arms following vigorous exercise. No trauma or skin lesions were observed. In non‐tropical areas, the etiology of pyomyositis can be related to muscle injury caused merely by exercise, without any other predisposing factors.

Treatment of Graf’s Ultrasound Class III and IV Hips Using Pavlik’s Method

AbstractWhen Pavlik introduced his method of treating congenital dislocation of the hip, he emphasized reducing the rate of osteonecrosis. Graf’s method of sonographic evaluation afforded earlier accurate diagnosis and subsequent treatment of developmental dysplasia of the hip. To ascertain whether treatment duration, gender, age at diagnosis, clinical stability, and/or treatment onset correlate with the risk of osteonecrosis in Graf Type III or IV hips, we clinically and sonographically screened 18,067 neonates (36,134 hips) for developmental dysplasia of the hip over a 4-year period; 151 had Graf Type III or IV hips, and 78 of these were treated by us and had known outcomes. Of these 78 hips, 65 (0.18%) had Graf Type III and 13 (0.036%) had Graf Type IV hips. Sixteen of the 65 Type III hips (25%) reduced spontaneously. Using Pavlik’s method, reduction was achieved in 46 of 65 (88.5%) Type III hips and eight of 13 Type IV hips. None of the hips treated exclusively by Pavlik’s method developed osteonecrosis. Thus, the method achieves one of Pavlik’s original goals of decreasing osteonecrosis incidence to close to zero. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Neonatal incidence of hip dysplasia: ten years of experience.

AbstractThe advantages of sonographic examination are well known, but its main disadvantage is that it might lead to overdiagnosis, which might cause overtreatment. Variations in the incidence of developmental dysplasia of the hip are well known. We ascertained the incidence of neonatal sonographic developmental dysplasia of the hip without considering the development of those joints during followup. All 45,497 neonates (90,994 hips) born in our institute between January 1992 and December 2001 were examined clinically and sonographically during the first 48 hours of life. Sonography was performed according to Graf’s method, which considers mild hip sonographic abnormalities as Type IIa. We evaluated the different severity type incidence pattern and its influence on the total incidence during and between the investigated years. According to our study, sonographic Type IIa has major effects on the incidence of overall developmental dysplasia of the hip with a correlation coefficient of 0.95, whereas more severe sonographic abnormalities show relatively stable incidence patterns. Level of Evidence: Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Prevention of ulnar nerve injury during fixation of supracondylar fractures in children by 'flexion-extension cross-pinning' technique.

No consensus exists concerning the best pin configuration for displaced supracondylar fractures of the humerus in children. Although cross-pinning is the most stable biomechanically, this configuration may cause iatrogenic ulnar nerve palsy. For the last 7 years, we have been using a three-pin fixation technique with insertion of two K wires from the lateral side (elbow in full flexion) and the third wire through the medial side (elbow in full extension). We used this technique in 67 displaced supracondylar fractures without any complications related to the ulnar nerve. The technique provides excellent stability and eliminates the risk of iatrogenic ulnar nerve palsy.

The use of the Taylor spatial frame in adolescent Blount’s disease: is fibular osteotomy necessary?

BackgroundThe standard treatment of adolescent Blount disease includes proximal tibial osteotomy and osteotomy of the fibula. Some believe that the fibula should also be fixed to prevent migration and subluxation. The purpose of the current study was to examine the results of treatment of patients with adolescent tibia vara treated by tibial osteotomy and Taylor spatial frame (TSF) without fibular osteotomy.MethodsCorrection of deformities was performed on eight patients (ten tibias) with adolescent Blount disease using TSF. The fibula was not osteotomized in any patient and was not fixed in the last five patients.ResultsAll patients had precise anatomical correction of deformities and no problems related to the fibula occurred during or after correction.ConclusionBased on our experience we believe that placement of the origin at the level of the proximal tibial fibular joint in conjunction with external fixation eliminates the need for fibular osteotomy and the potential morbidity of this procedure in patients with mild to moderate tibia vara.

Acute rupture of achilles tendon in a 7-year-old girl.

Ruptures of Achilles tendon are a relatively common injury. Ruptures typically occur after the age of 30 years, and are more frequent in people of middle age or older. In children, rupture of the tendon is usually due to avulsion of the tendon from the calcaneus but not within the tendon itself. We describe a 7-year-old girl successfully treated conservatively for acute tear of her Achilles tendon. No general predisposing disease was found. We were unable to find any description of an acute rupture of the Achilles tendon in a child under the age of 10 years.

Developmental dysplasia of the hip incidence in Ethiopian Jews revisited: 7-year prospective study.

We describe the sonographic and true incidence of developmental dysplasia of the hip among Ethiopian Jews compared with the general Israeli population. Previous results were based on a small number of Jewish Ethiopian children; this study is based on over 7 years of experience, during which 34 048 newborns, 768 of whom were Ethiopian, were examined clinically and sonographically. The incidence of sonographic developmental hip dysplasia was 5.5% in the general Israeli population, compared with 1.24% for the Ethiopian Jews. True developmental hip dysplasia incidence for Arabs and other Jews was 0.51%, as compared with 0.15% in the Ethiopians. Our data support the theory that either a single unknown gene or a multiple gene system plays a major role in the incidence of the dysplasia.

Non-Tropical Pyomyositis in Children–with Report of Severe Neurological Complications

ABSTRACT. Pyomyositis appears to occur rarely in temperate climate areas, compared with the incidence of the disease in the tropics. Three young adults with pyomyositis have previously been described in Israel, two of them were newly arrived Ethiopian immigrants. We report three Israeli children with pyomyositis, who presented initially with nonspecific abdominal pain; in one child the course was complicated by spinal cord compression due to extension of the infected mass into the spinal canal. All three patients attained full recovery after antibiotic therapy and surgical drainage. Computed tomography was most valuable in establishing the diagnosis and defining the extent of the process.