Comparison of Pediatric and General Orthopedic Surgeons’ Approaches in Management of Developmental Dysplasia of the Hip and Flexible Flatfoot: the Road to Clinical Consensus
Publish place: The Archives of Bone and Joint Surgery، Vol: 5، Issue: 1
Publish Year: 1396
نوع سند: مقاله ژورنالی
زبان: English
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JR_TABO-5-1_008
تاریخ نمایه سازی: 18 تیر 1398
Abstract:
Developmental dysplasia of the hip (DDH) and flatfoot are common pediatric orthopedic disorders, being referred to and managed by both general and pediatric orthopedic surgeons, through various modalities. Our study aimed to evaluate their consensus and perspective disagreements in terms of diagnostic and therapeutic approaches of the mentioned deformities. Forty participants in two groups of general orthopedic surgeons (GOS) (n=20) and pediatric orthopedic surgeons (POS) (n=20), were asked to answer an 8-item questionnaire on DDH and flexible flatfoot. The questions were provided with two- or multiple choices and a single choice was accepted for each one. Chi-square and Fisher’s exact tests was performed to compare the responses. For a neonate with limited hip abduction, hip ultrasonography was the agreed-upon approach in both groups (100% POS vs 71% GOS), and for its interpretation 79% of POS relied on their own whereas 73% of GOS relied on radiologist’s report (P=0.002). In failure of a 3-week application of the Pavlik harness, ending it and closed reduction (57% POS vs. 41% GOS) followed by surgery quality assessment with CT scan (64% POS vs. 47% GOS) and without the necessity for avascular necrosis evaluation (79% POS vs. 73% GOS) were the choice measures. In case of closed reduction failure, open reduction via medial approach was the favorite next step in both groups (62% POS and 80% GOS). For the patient with flexible flat foot, reassurance was the choice plan of 79% of pediatric orthopedists. Our findings demonstrated significant disagreements among the orthopedic surgeons. This proposes insufficiency of high-level evidence.
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Authors
Ramin Haj Zargarbashi
Orthopedics and Trauma Surgery Department, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
Hirbod Nasiri Bonaki
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Shayan Zadegan
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
Taghi Baghdadi
Orthopedics and Trauma Surgery Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran