Although hip ultrasonography is gaining acceptance as the most effective method for the early diagnosis of developmental dysplasia of the hip, there is still some controversy regarding the use of ultrasonography as a screening method. The purpose of this study was to investigate prospectively the capacity of clinical examination findings and associated risk factors to detect developmental dysplasia of the hip defined ultrasonographically in infants. A total of 3,541 infants underwent clinical examination and hip ultrasonography. Measured against ultrasonography as a standard, the sensitivity and specificity of clinical examination were 97% and 13.68%, respectively. Graf type IIb or more severe developmental dysplasia was found in 167 infants (208 hips), at an overall frequency of 4.71%. Graf type IIa physiological immaturity was encountered in 838 hips, and of these, 15 hips (1.78%) developed Graf type IIb dysplasia and underwent treatment. Patient characteristics that were found to be significant risk factors were swaddling use, female gender, breech delivery and positive family history. Given its low specificity, our findings suggest that clinical examination does not reliably detect ultrasonographically defined developmental dysplasia of the hip in infants being screened for this disease.
A new knife with its own battery powered light source (Knifelight, Stryker Instruments, Kalamazoo, Michigan, USA) was used for carpal tunnel release in 31 wrists of 25 patients. Under local anaesthesia, a short palmar incision was used and the carpal tunnel contents were visualized during division of the flexor retinaculum. The mean operation time was 11 minutes and no major complications were seen. The patients could use their hands for self-care after 3 days and returned to work at a mean of 23 days. At a minimum follow-up of 6 months, all but one of the patients were satisfied with the final result. Mild scar tenderness was seen in two patients and pillar pain in one patient.
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