Aims: Evaluation of the clinical and radiological results after primary surgical treatment of CDH in children with late discovered CDH. Methods: We have studied 64 hips of 58 patients (51 female and 7 male), who were between 18 months-8 years old with late discovered CDH. The study was made between 1991–2000. Teratological and neuromuscular cases were excluded. None of the patients have had previous treatment before admission in hospital. Preoperative radiographic evaluation of the cases was made based on the Tšnnis classiþcation system (12-gr.I, 26-gr.II, 19-gr.III, 7-gr.IV). Preliminary traction was used in 5 hips (4 patients). 8 of them were treated by open reduction, 18 by open reduction and pericapsular osteotomy of the ilium described by Pemberton, 38 by combined pelvic osteotomy (29 Pem-berton osteotomy, 9 Chiari osteotomy) and femoral derotation and/or varus osteotomy (with femoral shortening in 8 cases). Postoperatively, a plaster cast was applied for 6 weeks. Average follow-up period was 6.8 years. Results: The radiological results are based on Severin Classiþcation. We obtained in 77.5% of the cases excellent, good and satisfactory results. Using the clinical rating system of Fergusson and Howard, the results were good and satisfactory in 78.8 of the cases. Avascular necrosis occurred in 6 cases, being rated as group II and III according to the Kalamchi and Mac Ewen classiþcation system. Conclusions: In case of late discovered CDH, the results of conservative treatment are not satisfactory, the surgical treatment being recommended. Four years old or elder children can be treated safely with one stage operation consisting of open reduction, pelvic osteotomy with or without femoral derotation and varus osteotomy (with shortening if it is necessary).

Aims: The late effect of intramedullary nailing of the femur on proximal femur growth, particularly on growth plate of the greater trochanter and femoral neck, being known that losing the balance in the growth of the three ossiþcation points of the femurñs proximal extremity, the gap canñt be compensated by the greater trochanterñs remaining growth cartilage. Methods: During 1980–1995 we have performed 55 intramedullary femoral osteosyn-theses using KŸntscher rods in children 5–14 years of age. We have had the opportunity to observe 29 children during their later somatic growth: 25 femoral diaphyseal fractures and 4 non-unions. The average folow-up period has been 8.3 years. The patientñs average age has been 9,5 years. The hips were evaluated clinically for walking, mobility, limb length discrepancy. Radiological evaluation was based, according to Edgren, on following parameters of the joint architecture: cervico-diaphyseal angle (CDA), articulo-trochanteric distance (ATD), intertro-chanteric distance (TTD), femoral neck diameter (FND). Results: Clinical, one child presented 1.3 cm femur shortening. The evaluation of the radiological parameters on coxo-femoral joint showed increased CDA value between 10–30¡ in 8 children, increased ATD value (10–20mm) in 7 children, reduction of the TTD value in 6 patients and reduction of the FND (5–10mm) in 3 children. Conclusions: Insertion of intramedullary nail via the greater trochanter should be avoided in children less than 13–14 years of age, having tardy valgus effect and thinning of the femoral neck. We recommend osteosynthesis with plate and screws or, in little ones, transfragmentar screws, followed by immobilisation in plaster cast.