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We present the results - assessed after bony maturation - of an early anterior approach open reduction performed using our modified technique on 49 hips at 6-24 months of age. We start postoperative functional treatment using a Pavlik harness and an abduction splint, abandoning plaster cast. Secondary surgeries were performed in 11 hips (22.4%) at 3-7 years of age. Our results were 'satisfactory' (Severin Grade I, II) in 96% of the cases. According to the joints' Severin Grade, the total hip replacement probability at an early age is 8.16% in our series. Our principles and practice, introduced in 1980 in terms of secondary surgeries, are in total harmony with the recent literature.

Objective: To assess the prevalence of intuitive decision-making (IDM) among health care practitioners (HCPs) and explore its person-and job-specific factors. Design and Outcome Measures: We used on-line survey data from a cross-sectional sample of Hungarian physicians and nurses (N = 460) to assess their reliance on IDM. In a second survey we asked physicians (N = 104) to rate medical specialties on dimensions of 'emergency' (necessity of making instantaneous decisions in unforeseeable situations) and 'complexity' (necessity of considering multiple perceptual and diagnostic aspects of patients' health condition along with diverse treatment options). Results: Altogether 40% of participants reported ever relying on IDM. Using logistic regression analysis, we found the estimated probability of IDM was 0.24 greater for physicians than for nurses, 0.10 greater for females than for males, and 0.11 greater for advanced level HCPs than for novices. Reaching expert level further increased (by 0.31) the probability of IDM for physicians, but not for nurses. Concerning physicians, practicing in a medical specialty of 'high likelihood of emergency' or 'high complexity' increased the probability of IDM by 0.25 and 0.23; the same effects for nurses were 0.20 and 0.07. We found some (inconclusive) evidence for education positively influencing HCPs' propensity for IDM. Additionally, we performed content analysis of participants' free-text answers to explore the psychological background of IDM instances. HCPs educated in the subject of IDM were found more disposed to perform or request further medical investigation, less prone to deviate from medical protocols, apter to reflect on their mental processes, and more inclined to rely on a large scope of information for their decisions. Conclusions: The associations between job-and person-specific factors and HCPs' propensity for IDM may have implications for their training and allocation in the health care system. Education has great potential for enhancing the quality of IDM in clinical practice.

Recommendations will be made to improve medical care in orthopaedic procedures. The quality of evidence will be rated using GRADE criteria. Copyright © 2016 John Wiley & Sons, Ltd.

This study examined whether positive suggestions applied without a hypnotic induction in the perioperative period reduces the need for red blood cell transfusions in patients who underwent total hip or knee arthroplasties with spinal anesthesia. No hypnotic assessment was performed. Ninety-five patients were randomly assigned to the suggestion group (n = 45) and to the control group (n = 50). Patients in the suggestion group received verbal suggestions before and audiotaped suggestions during the surgery for reducing blood loss, anxiety, postoperative pain, and fast recovery. Our study showed that using positive suggestions in the perioperative period significantly decreases the necessity for transfusion.

One form of renal osteodystrophy secondary to chronic renal failure is the osteitis fibrosa cystica, which is the complication of secondary hyperparathyroidism. Osteitis fibrosa cystica is a histologically benign, tumor-like lesion of bones. Since early diagnosis and treatment of hyperparathyroidism is available nowadays, the development of osteitis fibrosa cystica has become rare. It can only be found in neglected cases and in those where the treatment of chronic renal failure is unsuccessful. We present the case of a boy, who developed osteitis fibrosa cystica as a complication of secondary hyperparathyroidism. Our article is the first to report a case about an osteitis fibrosa cystica found in a child’s vertebra and this tumor was the only one, which reached a size of approximately 10 × 15 × 15 cm. We present the CT films and X-ray pictures, the surgical solution and the results of the histological examination

Bevezetés és célkitűzés:Prospektív tanulmányunk célja a gyermekkori csuklótörések ultrahang-diagnosztikájának ismertetése és két mozgásszervi centrum eredményének bemutatása. Módszer: 2011 januárja és 2015 decembere között 467, 1-15 év közötti gyermek ultrahangvizsgálatát végeztük el. Valamennyi gyermek zárt sérülést szenvedett el és nyitott epiphysisfugával rendelkezett. Az ultrahangvizsgálatot rezidensek és ortopéd-traumatológus, illetve gyermeksebész szakorvosok végezték közvetlenül az elsődleges fizikális vizsgálatot követően, 7-14 MHz frekvenciatartományú lineáris transzducerekkel. Az eredményeket hagyományos kétirányú csukló-röntgenfelvételekkel hasonlítottuk össze. Eredmények: 97%-os szenzitivitást és 96%-os specificitást találtunk. Elmozdulással és komolyabb klinikai konzekvenciával járó törések ultrahanggal is mind felismerésre kerültek. Következtetés: A mozgásszervi ultrahangvizsgálat a gyermekkori csuklótáji törések igazolásának vagy kizárásának rendkívül hatékony eszköze a napi gyakorlatban. Orv Hetil. 2017; 158(24): 944-948. Kulcsszavak: ultrahang, gyermekkor, csuklótörés Ultrasonographic diagnosis of distal pediatric forearm fracturesIntroduction and aim: The aim of our prospective study was to evaluate the effectivity of sonographic diagnosis of pediatric wrist fractures and analyzing the results of two pediatric musculoskeletal centers. Method: Between 2011 January and 2015 December 467 children aged 0-15 with closed wrist injuries and open growth plates were sonographically and radiologically evaluated by an orthopaedic surgeon or a resident in trainee. Sonography was performed immediately after physical examination with linear probes of 7-14 Mhz frequency. Results were compared to conventional two plane wrist x-rays. Results: We found 97 sensitivity and 96 specificity of the sonographic evaluation. Fractures with dislocations and more serious clinical consequences were never missed. Conclusion: Musculoskeletal ultrasound is a very effective tool in daily routine for diagnosing or excluding pediatric wrist fractures.

In the Department of Orthopaedic Surgery in the University of Debrecen, Debrecen, Hungary, we examined the effectiveness of positive suggestions used in the perioperative period in hip and knee arthroplasties performed under spinal anaesthesia. The goal of the suggestions was to reduce the need for red blood cell transfusion and for analgesics, and to increase the patients' satisfaction. The objective of this article is to present our method with concrete examples of positive suggestions which were given first before the surgery (via personal conversation), then during the operation as well (via audiotaped method). We hope that our article will contribute to the wide-spread awareness of this relatively easy to learn communication method.