Operative treatment and avascular necrosis of the hip development disorder.
OBJECTIVE
The purpose of this research was (1) to evaluate the consequences of an operative treatment of hip developmental disorder in children, (2) to evaluate the significance of hip vascular supply in children through indirect radiological signs, such as morphological changes on femoral head, and to classify them with standard classification methods, and (3) to analyse the research results and make a recommendation for the following treatment dilemma: when is the optimal time for an operative treatment of a hip development disorder?


METHODS
The research is a retrospective and observational analysis based on the classification of indirect radiological signs of local vascular disorder by the Bucholz-Ogden's scale. Materials used for this research are medical records of treated patients at the Clinic for Orthopaedics and Traumatology of the Sarajevo University Clinical Centre. Using a random selection, two groups of 30 patients with hip development disorder were formed. The first group was comprised of patients aged six to 18 months and the second group of patients aged 18-60 months. The medical records used for this research included all necessary anamnestic details and postoperative state treatments with clinical findings and regular radiological check-up findings that include the presence or absence of the ossification nucleus as well as its position. All patients underwent surgery with the same operative technique. Data analysis points include the state at the beginning of the treatment, the postoperative state, the state at discharge as well as control findings that followed the development of the proximal femoral part up to 72 months on average. The analysis covered data such as age, sex, family anamnestic data, clinical findings and radiological findings regarding the femoral head morphology (appearance, size, shape, position and indirect signs showing lack of vascular supply). In addition, data analysis included the types of any previous conservative or operative treatments, the duration of previous conservative treatments and repeated hospitalization.


RESULTS
In group 1, 86.6 % were female patients and 80 % in group 2. Family history was positive in 15.6 % in group 1 and 13.3 % in group 2. A total of 51.6 % of all patients started walking on time, while the rest had problems with verticalization. Of all patients, 47 % did not undergo any kind of prior treatment. Only 62.2 % of group 1 patients had ossification nucleus present, while the entire group 2 had it present. Results showed that 24.32 % of group 1 patients had none or minimal signs of avascular necrosis (AVN) while 39.47 % of group 2 had none or minimal signs of AVN; 60.52 % of group 2 patients had signs of AVN.


CONCLUSIONS
The results of this study show that the performance of a surgical treatment during the age between 12 and 20 months is burdened by the highest percentage of avascular necrosis. Even though AVN can be noticed in other age groups, according to the results of our research, it seems that vascular supply of the hip is the most vulnerable in the period between 12 and 20 months.
Clinic for Orthopaedics and Traumatology, Sarajevo University Clinical Centre, Bolnička 25, 71000, Sarajevo, Bosnia and Herzegovina, ismetcap@ortotrauma.com.ba.
Ismet
I
Gavrankapetanović
Amel
A
Hadžimehmedagić
Adnan
A
Papović
Elvir
E
Baždar
D002675:Child, Preschool; D005260:Female; D005270:Femur Head / Q000098:blood supply; D005271:Femur Head Necrosis / Q000601:surgery*; D006618:Hip Dislocation, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008349:Manipulation, Orthopedic; D012189:Retrospective Studies; D013997:Time Factors