RESUMO
INTRODUCTION: Because of the risk of developmental dysplasia of the hip in infants born breech-despite a normal physical exam-the American Academy of Pediatrics (AAP) guidelines recommend ultrasound (US) hip imaging at 6 weeks of age for breech females and optional imaging for breech males. The purpose of this study is to report US results and follow-up of infants born breech with a normal physical exam. METHODS: The electronic medical record for children born at 1 hospital from 2008 to 2011 was reviewed. Data were analyzed for sex, birth weight, breech position, birth order, ethnicity, US and x-ray results, follow-up, and cost. RESULTS: A total of 237 infants were born breech with a normal physical examination, all delivered by cesarean section. Of the infants, 55% were male and 45% female. About 151 breech infants (64%) with a normal Barlow and Ortolani exam had a precautionary hip US as recommended by the AAP performed at an average of 7 weeks of age. Eighty-six breech infants (35%) did not have an US and were followed clinically. Of the 151 infants that had an US, 140 (93%) were read as normal. None had a dislocated hip. Two patients had a normal physical exam but laxity on US. These 2 patients were the only infants treated in a Pavlik harness. A pediatric orthopaedic surgeon followed those with subtle US findings and no laxity until normal. CONCLUSIONS: The decision by the AAP to recommend US screening at 6 weeks of age for infants with a normal physical exam but breech position was based on an extensive literature review and expert opinion. Not all pediatricians are following the AAP guidelines. The decision to perform an US should be done on a case-by-case basis by the examining physician. A more practical, cost-effective strategy would be to skip the US if the physical exam is normal and simply obtain an AP pelvis x-ray at 4 months. LEVEL OF EVIDENCE: Level III-this is a case-control study investigating the outcomes of infants on data drawn from the electronic medical record.
Assuntos
Apresentação Pélvica/cirurgia , Luxação Congênita de Quadril/diagnóstico , Instabilidade Articular/diagnóstico , Ultrassonografia/métodos , Estudos de Casos e Controles , Cesárea/métodos , Feminino , Humanos , Lactente , Masculino , Exame Físico/métodos , Gravidez , Medição de Risco/métodosRESUMO
BACKGROUND: Previous literature has underreported radiation exposure with the use of mini C-arm during pediatric forearm fracture reductions. The purpose of this study is to report an accurate amount of radiation exposure during fracture reductions using a mini C-arm that records the amount of kilovolts, milliamps, and the number of seconds of foot pedal use. METHODS: Eighty-six consecutive pediatric patients undergoing upper extremity fracture reduction in the emergency department were studied. The orthopaedic resident, either a PGY2 or PGY3, performed a manipulative reduction and casting of the fracture with use of the mini C-arm. Postreduction, in cast, anteroposterior and lateral images from the mini C-arm were saved to the computerized radiology system. The mini C-arm recorded the amount of kilovolts, milliamps, and the number of seconds that the foot pedal was used for each reduction. A radiology physicist (S.K.) calculated the amount of millirem (mR) exposure for each reduction from these data. RESULTS: The resident using the mini C-arm and the fracture pattern affected the amount of radiation exposure. The average mini C-arm mR exposure for distal radius fractures was 63 mR; forearm 109 mR; elbow 53 mR; and hand 69 mR. For comparison, conventional anteroposterior/lateral forearm radiographs emit an average of 20 mR. Less-experienced PGY2 residents had a higher mR exposure per reduction compared with PGY3 residents. CONCLUSIONS: Radiation exposure when using the mini C-arm for reduction of pediatric fractures has been underestimated in previous literature. Radiation from the mini C-arm exceeded that from conventional radiographs in most cases. We recommend that residents receive training about the use of the mini C-arm before its utilization as an aid to reduce pediatric fractures in the emergency department.