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Query: UMLS:C0029713 (immaturity)
 4,335 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study was to report eight additional cases of habitual dislocation of the hip (HDH) and to combine the authors' data with a compilation of the cases from the literature. The authors attempted to investigate the various causative factors, outcomes, and indications for conservative and operative treatments. The results suggest that an unusual ability to dislocate the hip voluntarily at a young age constitutes a specific pediatric entity, and no single factor can be determined to be the definite cause of HDH. Multiple triggering factors (generalized ligamentous laxity, excessive anteversion of the femur and acetabulum, osteocartilaginous defect of acetabulum, coxa valga, psychiatric immaturity) appear to be associated with HDH. Treatment should be conservative in the first instance; it includes simple observation with or without psychiatric counseling and immobilization with cast or brace. Hip stabilization by surgical means is selectively indicated when the episodes of hip dislocation do not fade away in due time despite conservative treatment and when primary or secondary capsular laxity or osteocartilaginous deformation or defect of the hip is severe enough to cause repeated dislocation or residual subluxation, which may cause persistent pain or discomfort.
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PMID:Habitual dislocation of the hip in children: report of eight additional cases and literature review. 1260 47

Questions persist concerning the incidence of total hip arthroplasties (THAs) attributable to secondary osteoarthrosis and the impact of corrective pediatric hip surgeries and retained internal fixation on subsequent THAs. Hip reconstruction fellowship directors (N = 72) were mailed a survey of multiple-choice questions about pediatric hip disorders (PHDs) in their THA populations, the influence of hip osteotomies on subsequent THAs, and the recommendation to routinely remove pediatric hip internal fixation. Forty-five surgeons (62.5%) responded. The majority reported that a small proportion of hip arthrosis in their practice was attributable to PHDs (10-30 cases per 100-200 annual cases). Fifty-seven percent indicated that hip surgery performed during skeletal immaturity made THA more difficult. Twenty-eight surgeons (62% of respondents) said that they remove implants from fewer than 10% of cases with previous pediatric surgery. Sixty-eight percent felt that removal of pediatric hip implants, particularly those in the proximal femur (83% of respondents), should be routine. Survey results showed that the majority of experts in adult hip reconstruction (a) do not identify PHDs as a significant factor in most of their patients with end-stage hip arthrosis and (b) believe in routine removal of pediatric hip implants, particularly those in the proximal femur. The impact of performing corrective hip surgery during skeletal immaturity--whether such surgery increases the difficulty of or diminishes the effectiveness of subsequent THA--remains controversial.
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PMID:Sequelae of pediatric hip disorders: survey responses from experts in adult hip reconstruction. 1843 71

Developmental dysplasia of the hip (DDH) encompasses a wide spectrum of clinical severity, from mild developmental abnormalities to frank dislocation. Clinical hip instability occurs in 1% to 2% of full-term infants, and up to 15% have hip instability or hip immaturity detectable by imaging studies. Hip dysplasia is the most common cause of hip arthritis in women younger than 40 years and accounts for 5% to 10% of all total hip replacements in the United States. Newborn and periodic screening have been practiced for decades, because DDH is clinically silent during the first year of life, can be treated more effectively if detected early, and can have severe consequences if left untreated. However, screening programs and techniques are not uniform, and there is little evidence-based literature to support current practice, leading to controversy. Recent literature shows that many mild forms of DDH resolve without treatment, and there is a lack of agreement on ultrasonographic diagnostic criteria for DDH as a disease versus developmental variations. The American Academy of Pediatrics has not published any policy statements on DDH since its 2000 clinical practice guideline and accompanying technical report. Developments since then include a controversial US Preventive Services Task Force "inconclusive" determination regarding usefulness of DDH screening, several prospective studies supporting observation over treatment of minor ultrasonographic hip variations, and a recent evidence-based clinical practice guideline from the American Academy of Orthopaedic Surgeons on the detection and management of DDH in infants 0 to 6 months of age. The purpose of this clinical report was to provide literature-based updated direction for the clinician in screening and referral for DDH, with the primary goal of preventing and/or detecting a dislocated hip by 6 to 12 months of age in an otherwise healthy child, understanding that no screening program has eliminated late development or presentation of a dislocated hip and that the diagnosis and treatment of milder forms of hip dysplasia remain controversial.
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PMID:Evaluation and Referral for Developmental Dysplasia of the Hip in Infants. 2794 Jul 40

Early excision of heterotopic ossification was performed in 8 patients at an average of 10.2 months after total hip arthroplasty. All patients received a single irradiation dose of 7Gy the day before the operation, followed by oral indomethacin (3x25mg/day) for six weeks. Continuous passive mobilization under epidural anesthesia was started immediately post-operatively. At an average follow-up of 2 years none of them had radiographic or clinical evidence of recurrence. Consequently we recommend resection as soon as there are severe clinical implications, even when bone scans indicate immaturity of the heterotopic ossification and provided that the resection is combined with proper non-surgical treatment consisting of irradiation and oral indomethacin and immediate extensive rehabilitation program. (Hip International 2002; 4: 383-7).
Hip Int
PMID:Early resection of heterotopic ossification after total hip arthroplasty: A review of the literature. 2812 40

The hip is the joint most exposed to orthopaedic complications in cerebral palsy (CP), which is the main cause of spasticity in paediatric patients. The initial immaturity of the hip allows the forces applied by the spastic and retracted muscles to displace the femoral head, eventually causing it to dislocate. The risk of hip dislocation increases with the severity and extent of CP, exceeding 70% in the most severe cases. Hip dislocation causes pain in up to 30% of cases, carries a risk of orthopaedic and cutaneous complications and hinders patient installation and nursing care. These adverse outcomes warrant routine screening, which has been proven effective in lessening the frequency and severity of hip displacement. Preventive techniques including physical therapy, orthoses and treatments to alleviate spasticity are strongly recommended in every case. The beneficial effects of treating spasticity, if needed via neurosurgical procedures, have been convincingly established. Orthopaedic surgery is required when prevention fails. Soft-tissue release is designed to correct the asymmetry in the forces applied by the muscles. Femoral osteotomy creates the possibility for spontaneous correction of secondary acetabular dysplasia. Progress has been made in standardising the use of multilevel surgery involving the soft tissues, femur and pelvis, which is often effective in correcting the morphological abnormalities and stabilising the joint. When hip pain or alterations are severe, hip resection or total hip arthroplasty are highly effective in alleviating the pain and improving patient comfort. The spastic hip is a complex condition in which currently available screening protocols and treatment strategies have been proven effective in benefitting patient outcomes.
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PMID:The spastic hip in children and adolescents. 3005 40