Diferentes índices radiográficos versus Índice Acetabular en la decisión de colocación de Arnés de Pavlik en pacientes con diagnóstico de Displasia de Cadera

Abstract

There are different x-ray indices and classifications for the diagnosis of Hip Developmental Dysplasia, this study compared the usefulness of different x-ray parameters in patients with high acetabular indices to determine whether or not would benefit from orthopedic treatment. Patients and Methods: Retrospective cohort study. Patients aged 3 to 7 months, attended in the external consultation of Traumatology and Pediatric Orthopedics of the Hospital Vozandes Quito in the period January to December 2017 were included in the study. Signs of hip instability to physical examination, radiographic measurements: acetabular index, percentage of femoral head migration, Smith index, Tonnis classification by quadrants, formation of the radiographic acetabular eyebrow were obtained from the medical record of each patient. Results: 104 patients were evaluated, the median age at the time of diagnosis was 4.63 months, 52% were male and the mean acetabular index was 37.9 degrees. Patients were subdivided into 2 groups according to the orthopedic treatment instituted: with Pavlik harness (38.5%) and without a harness (61.5%). When comparing patients without and with harness we got an OR of 1.07 and a value of p-0.69. Patients with a Grade I Tonnis scale had a 96% chance of developing a normal hip relative to Tonnis Grade II (60%), with an OR of 21.3 and p-0.69. Conclusions: There is a group of patients with a high acetabular index and hips stable to the physical examination who would not benefit from orthopedic treatment, within all the parameters evaluated we observe that the normal radiographic acetabular eyebrow and the Tonnis scale grade I were predictor parameters of a good response at 2 months.