Monday, October 31, 2011

Late diagnosis of developmental dysplasia of the hip: an analysis of risk factors.

J Pediatr Orthop B. 2011 Jan;20(1):1-7.
Azzopardi TVan Essen PCundy PJTucker GChan A.


Source

Royal Hospital for Sick Children, Glasgow, UK. thomasazzopardi@hotmail.com

Abstract

A neonatal clinical screening program for developmental dysplasia of the hip (DDH) operates in South Australia to diagnose DDH as early as possible. However, some cases of DDH are diagnosed late (>3 months of age). The aims of this study were to identify the specific risk factors for late diagnosis by comparing early diagnosed DDH, late diagnosed DDH, and normal controls in the South Australian population. There were 1945 children with DDH born between 1988 and 2003, of which 67 cases were late diagnosis (3.4%). Maternal characteristics, pregnancy, and delivery details were analyzed, and compared with controls (early diagnosed DDH and the general population). There was a trimodal pattern of age at presentation with a gradual increase in the incidence of late diagnosed DDH over the time period in this study. Birthweight (<2500 g), birth in a rural setting, and early hospital discharge following delivery (<4 days) were significant risk factors for late diagnosed DDH. Breech presentation and delivery by caesarean section were protective for late diagnosed DDH. Risk factors for late diagnosed DDH relate to factors that influence the screening program. A rigorous population-based hip surveillance program is important for early diagnosis of DDH.
IORG Paediatric orthopaedic update

Friday, October 28, 2011

Effect of pressure applied during casting on temperatures beneath casts.

J Pediatr Orthop. 2011 Oct-Nov;31(7):791-7.
Deignan BJIaquinto JMEskildsen SMWoodcock CAOwen JRWayne JSKuester VG.



Abstract

BACKGROUND:

Burns and pressure sores are common injuries during cast application. Various factors such as water temperature, padding, and cast material layers may play a role in these injuries; however, the effect of cast molding on temperatures and pressures has not been investigated. This raises the following questions, does the application of molding during cast application: (1) alter skin level temperatures in a variety of cast materials? and (2) risk inducing either thermal injury or pressure necrosis?

METHODS:

An upper extremity model was created to measure pressure and temperature underneath casting materials. Cast padding, water bath temperature, and cast thickness were standardized. A 3-point mold was simulated using 3 casting materials-Fiberglass only, Plaster Only splint, and Plaster splint overwrapped with Fiberglass-while pressure and temperature were recorded.

RESULTS:

: Pressure application led to a statistically significant (P<0.0001) increase in temperature at the sites where the mold was applied although absolute temperature did not reach the theoretical burn threshold of 49 to 50°C for the casting materials studied. With pressure applied, the Plaster/Fiberglass combination reached an average peak temperature of 47.9°C, which was maintained for up to 6 minutes. Neither Fiberglass nor Plaster Only reached peak temperatures of this magnitude (average of 42.7 and 43.6°C, respectively). Peak (369 mm Hg) and highest residual (21 mm Hg) pressures were below harmful levels.

CONCLUSIONS:

Pressure application during casting is a risk factor for burn injuries. Care should be taken when molding a plaster splint overwrapped in fiberglass by waiting until the plaster has fully cooled.

CLINICAL RELEVANCE:

Combined with other known risk factors, the pressure from molding a cast could increase the likelihood of causing cutaneous burns.

IORG Paediatric Orthopaedic Update