Introduction?Abnormalities of the bony pelvis in exstrophy-epispadias complex (EEC) and their possible relation to hip disease are well described. However, there is a lack of information about long-term orthopedic consequences and hip function in patients with EEC. Therefore, we investigated clinical and radiological results in an EEC patient cohort after long-term follow-up.
Patients and Methods?We conducted a cross-sectional study using standardized radiography, clinical investigation, and the Harris hip score. Seventeen postpuberty consecutive unselected EEC patients (3 female, 14 male; mean age 18.2 years) that presented to our clinic due to urological procedures or routine check-up from 2010 to 2011 were included. All had undergone symphysis approximation with a traction bandage without osteotomy in early childhood. Radiological analysis was conducted offline by two independent investigators.
Results?Radiological analysis showed a mean pubic diastasis of 5.1 cm (range 2.8?8.5 cm). Borderline hip dysplasia was present in four patients, one of them having had co-occurring developmental hip dysplasia in previous history. No severe dysplasia, subluxation, or luxation of the hip was found; however, one patient showed early hip arthrosis. Clinical examination revealed no relevant restriction of range of motion, although rotation and abduction were slightly altered in five patients. None of the EEC patients complained about pain or restriction in sports or daily activities. Harris hip score was perfect for all but one study participants.
Conclusion?Despite EEC-specific hip morphology, long-term hip function is not impaired in patients after symphyseal approximation without osteotomy in the newborn period. The symphysis diastasis after this procedure is comparable to available postosteotomy data. The large majority of EEC patients did not show dysplastic or degenerative hip disease. Functional hip score results confirmed reasonable age-related hip function in nearly all examined patients. However, postnatal ultrasound hip screening is recommended to prevent and adequately treat potential co-occurring developmental hip dysplasia.
Behandlung der Femurschaftfraktur im Wachstumsalter Vom Beckenbeingips bis zur elastisch stabilen intramedullären Nagelung Inzidenz und Pathophysiologie Frakturen des Femurschaftes machen etwa 1-3 % aller Frakturen im Wachstumsalter aus [1, 2]. Hierbei zeigt die Altersverteilung 2 wesentliche Altersgipfel: Der erste Gipfel liegt zwischen dem 2. und 4. Lebensjahr, der zweite im Alter der Pubertät [3]. Etwa ein Drittel aller Femurschaftfrakturen findet sich bei Kindern bis zum 3. Lebensjahr. Dieser Häufigkeitsgipfel erklärt sich durch den primär weichen Aufbau des Femur beim Neugeborenen und den erst in den ersten Lebensjahren vollzogenen Umbau zum laminären Abb. 1 8 Konservative Behandlung einer misshandlungsbedingten Femurschaftfraktur mit Overheadextension bei einem 7 Monate alten Kind. Nach 2 1/2 Wochen zeigt sich bereits eine ausreichende Konsolidierung. a Röntgen am Aufnahmetag, b Konsolidation nach 2 1/2 Wochen in der Overhead-Extension Abb. 2 8 Overheadextension bei einem 2-jährigen Kind Trauma und Berufskrankheit • Suppl 1 • 2018 S1
In Germany, the majority of wires are buried under the skin due to a fear of higher infection rates. In addition, other influencing factors such as pain and traditional approaches play a significant role. With respect to the results in the literature as well as a possible improvement of efficiency and avoidance of a second anesthesia, a multicentric clinical study seems necessary in the future to compare both techniques.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.