Optimal DDH screening timing and whether adding risk profiles could aid in detecting treatment outcome were investigated. Risk factors were employed to supplement ultrasound findings in flagging cases for follow-up. I...Optimal DDH screening timing and whether adding risk profiles could aid in detecting treatment outcome were investigated. Risk factors were employed to supplement ultrasound findings in flagging cases for follow-up. Initial screening results and harness treatment outcomes concordance were compared at different screening ages and screening protocols. Using clinical decision to supplement ultrasound screening allowed to accurately flag all 12 DDH treated cases upon initial visit. Clinical decision correctly identified cases that would have otherwise been missed (n = 2). However, doing so increased the rate of false positive cases at all time points of initial screening. Initial screens were more accurate for predicting treatment outcomes when using ultrasound only if done after 28 days [≤28 days (88.1%) vs. 29 - 56 days (98.5%), OR = 7.16, p < 0.001] or ultrasound with clinical decision [≤28 days (86.4%) vs. 29 - 56 days (95.7%), OR = 3.00, p < 0.001]. In contrast, screening after 56 days failed to marginally improve accuracy compared to screens done between 29 - 56 days, regardless of the screening protocol employed. Two important trade-offs emerged. First, when choosing timing of initial screening, optimal accuracy and harness treatment schedule should both be considered. Second, when considering whether to use a more conservative risk profile to supplement ultrasound findings, treatment accuracy and the ability to efficiently detect cases requiring harness treatment should both be considered. We provide evidence for performing an initial DDH ultrasound screen between 4 and 8 weeks (29 - 56 days), while employing clinical decision to aid in determining cases that require further follow-up evaluation.展开更多
BACKGROUND Congenital knee dislocation(CKD)is a rare condition,which accounts for 1%of congenital hip dislocations.It can present as an isolated condition or coexist with other genetic disorders.Treatment options incl...BACKGROUND Congenital knee dislocation(CKD)is a rare condition,which accounts for 1%of congenital hip dislocations.It can present as an isolated condition or coexist with other genetic disorders.Treatment options include serial casting,percutaneous quadriceps recession,and V-Y quadricepsplasty(VYQ).The pathogenesis and hereditary patterns of CKD are not fully understood,with most cases being familial.CKD is usually managed immediately after birth.However,in this report,the patient was neglected for 2 years.CASE SUMMARY A 2-year-old girl with bilateral CKD after birth presented to our hospital after failed serial casting;the patient had seizures and limited access to healthcare because of her family’s low socioeconomic status.Her birth was noted for a breech presentation accompanied by oligohydramnios.The delivery took a long time,requiring immediate medical interventions.As an infant,she had chronic diseases,including a small patent ductus arteriole,multicystic dysplastic kidney disease,and epilepsy.She was found to have a bilateral knee dislocation of approximately-90°on hyperextension.A multidisciplinary team was involved,and medical care was optimized.She underwent VYQ plus semitendinosus and sartorius transfer.After four postoperative follow-ups,her knees were regaining mobility,and she could walk for 2-3 steps without assistance.CONCLUSION This report highlights the importance of early intervention and recommends extensive studies of the management in similar cases.展开更多
文摘Optimal DDH screening timing and whether adding risk profiles could aid in detecting treatment outcome were investigated. Risk factors were employed to supplement ultrasound findings in flagging cases for follow-up. Initial screening results and harness treatment outcomes concordance were compared at different screening ages and screening protocols. Using clinical decision to supplement ultrasound screening allowed to accurately flag all 12 DDH treated cases upon initial visit. Clinical decision correctly identified cases that would have otherwise been missed (n = 2). However, doing so increased the rate of false positive cases at all time points of initial screening. Initial screens were more accurate for predicting treatment outcomes when using ultrasound only if done after 28 days [≤28 days (88.1%) vs. 29 - 56 days (98.5%), OR = 7.16, p < 0.001] or ultrasound with clinical decision [≤28 days (86.4%) vs. 29 - 56 days (95.7%), OR = 3.00, p < 0.001]. In contrast, screening after 56 days failed to marginally improve accuracy compared to screens done between 29 - 56 days, regardless of the screening protocol employed. Two important trade-offs emerged. First, when choosing timing of initial screening, optimal accuracy and harness treatment schedule should both be considered. Second, when considering whether to use a more conservative risk profile to supplement ultrasound findings, treatment accuracy and the ability to efficiently detect cases requiring harness treatment should both be considered. We provide evidence for performing an initial DDH ultrasound screen between 4 and 8 weeks (29 - 56 days), while employing clinical decision to aid in determining cases that require further follow-up evaluation.
文摘BACKGROUND Congenital knee dislocation(CKD)is a rare condition,which accounts for 1%of congenital hip dislocations.It can present as an isolated condition or coexist with other genetic disorders.Treatment options include serial casting,percutaneous quadriceps recession,and V-Y quadricepsplasty(VYQ).The pathogenesis and hereditary patterns of CKD are not fully understood,with most cases being familial.CKD is usually managed immediately after birth.However,in this report,the patient was neglected for 2 years.CASE SUMMARY A 2-year-old girl with bilateral CKD after birth presented to our hospital after failed serial casting;the patient had seizures and limited access to healthcare because of her family’s low socioeconomic status.Her birth was noted for a breech presentation accompanied by oligohydramnios.The delivery took a long time,requiring immediate medical interventions.As an infant,she had chronic diseases,including a small patent ductus arteriole,multicystic dysplastic kidney disease,and epilepsy.She was found to have a bilateral knee dislocation of approximately-90°on hyperextension.A multidisciplinary team was involved,and medical care was optimized.She underwent VYQ plus semitendinosus and sartorius transfer.After four postoperative follow-ups,her knees were regaining mobility,and she could walk for 2-3 steps without assistance.CONCLUSION This report highlights the importance of early intervention and recommends extensive studies of the management in similar cases.
