Adherence with follow up including footwear review minimises risk. Re-ulceration at 5 years is associated with risk of amputation. Ten-year mortality is high due to vascular complications.
The use of targeted ultrasound screening for ‘at risk’ hips in order to reduce the rate of surgery in developmental dysplasia of the hip (DDH) are unproven. A prospective trial was undertaken in an attempt to clarify this matter. Over an 8-year period, there were 28,676 live births. Unstable and ‘at risk’ hips were routinely targeted for ultrasound examination. One thousand eight hundred and six infants were ultrasounded, 6.3% of the birth population. Twenty-five children (18 dislocations and 7 dysplasias) required surgical intervention (0.87 per 1000 births for DDH / 0.63 per 1000 births for dislocation). Targeted ultrasound screening does not reduce the overall rate of surgery compared with the best conventional clinical screening programmes. The development of a national targeted ultrasound screening programme for ‘at risk’ hips cannot be justified on a cost or result basis.
Charcot neuroarthropathy is a progressive, destructive process occurring in the presence of neuropathy. We report the outcome of neuropathic foot joints presenting to our clinic over a 12 year period.
Cases were identified from the Diabetic Foot Clinic Register, 1989–2001. We studied patient demographics, clinical presentation, distribution, treatment and outcome.
Twenty-eight episodes of arthropathy occurred in 23 patients. Age at onset ranged from 40 to 79 years. Presentation was acute in 14 and subacute in the others. Sites affected included 23 mid foot, 4 ankle and 1 MTP. Nine feet were ulcerated at presentation, eight had a history of ulcer, nine have no ulcer history. Infection complicated the Charcot process in 15. Mean Hba1c at presentation was 9.3%.
Total contact casting 23, 4 “scotch cast” boots and 1 Air-cast walker. Pamidronate was given to 10 patients.
Three patients died. Two had below knee amputations. Casts were required for up to 12 months. Three required orthopaedic foot reconstructions. All ulcers present initially healed.
Charcot arthropathy remains uncommon. In our series treatment was successful in all but two patients in terms of preserved limbs, mobility and freedom from ulceration.
Aim: To compare the results of early splintage against delayed splintage with ultrasound surveillance in neonatal hip instability. Methods: Between 1992 and 1997, all unstable hips (Ortolani or Barlow positive) referred by the Paediat-ric Department were seen within 1 to 2 weeks of birth. They were assessed clinically and by static and dynamic ultrasound. Those with proven instability were treated in a Wheaton Pavlick splint. Between 1998 and 1999, with the same assessments made, all hips with proven instability were treated by close surveillance in the form of serial ultrasound and were splinted if there was persistent instability or dysplasia. Any neonate presenting later than 2 weeks was excluded from this study. Results: From 1992 to 1997, 37 neonates were treated with 59 unstable hips. Mean time to splintage was 6.35 days (1-14 days), and mean splintage time was 6.13 weeks (4-11 weeks). All patients in this group developed normally, and no surgical intervention was required. From 1998 to 1999, 11 neonates were treated with 16 unstable hips. 9 hips required splintage after an average of nine weeks. 7 hips stabilised with no splintage. Two hips required surgical intervention, one for ‘late’ dislocation and one for persistent dysplasia. These results show a statistically significant difference for the two treatment groups. (p=0.04, Fishers exact test) Conclusion: We conclude from these results that neonatal hip instability is best treated by splintage within two weeks of birth.
The use of targeted ultrasound screening for ‘at risk’ hips in order to reduce the rate of surgery in developmental dysplasia of the hip (DDH) is unproven. A prospective trial was undertaken in an attempt to clarify this matter. Over an 8-year period, there were 28, 676 live births. Unstable and ‘at risk’ hips were routinely targeted for ultrasound examination. One thousand eight hundred and six infants were ultrasounded, 6. 3% of the birth population. Twenty-six children (19 dislocations and 7 dysplasia) required surgical intervention (0. 91 per 1000 births for DDH/0. 66 per 1000 births for dislocation) Targeted ultrasound screening does not reduce the overall rate of surgery compared with the best conventional clinical screening programmes. The development of a national targeted ultrasound screening programme for ‘at risk’ hips cannot be justified on a cost or result basis.
