One hundred seventy-two patients with 204 slipped capital femoral epiphyses treated with nailing or pinning were evaluated an average of 28 years after surgery. Follow-up evaluation was obtained by questionnaire in 153 cases (181 hips) and by clinical and radiographic reexamination in 132 cases (157 hips). Segmental collapse was seen in four of 179 hips nailed/pinned in situ and in four of 25 hips operated after reduction. This was the only early complication associated with problems at reexamination. Arthrosis was twice as frequent after reduction (53%) than after fixation in situ (24%). The clinical and radiographic results were better than those from the same region after other methods of treatment. Nailing or pinning in situ is the method of choice when possible, regardless of the degree of slipping. Bilateral slipping was found in 67% of the hips; therefore, prophylactic pinning of the contralateral hip is indicated in cases with unilateral slipping.
Opinions differ concerning the treatment of choice for severe slipped capital femoral epiphysis, probably due to the lack of long-term follow-up evaluations on the different methods of treatment. A series of 33 patients with severe slipped capital femoral epiphysis, treated per primam with wedge osteotomy of the femoral neck, were radiographically and clinically reexamined an average of 28 years (range, 16-32 years) after the operation. Segmental collapse and/or chondrolysis developed in ten patients. Nine of these patients were available for reexamination and all had severe arthrosis with poor function. Arthrosis developed in nine of the 19 patients without signs of segmental collapse or chondrolysis; these patients had a satisfactory joint function. This series was compared with another series (from the same orthopedic departments) of patients with severe slip without any primary treatment. The long-term results in these two groups were similar; consequently, the value of realignment by wedge osteotomy of the femoral neck is questionable.
Five hundred thirty-two cases of slipped capital femoral epiphysis (physiolysis colli femoris--PCF) treated at three orthopedic departments in southern Sweden between 1910 and 1982 were used for epidemiologic studies. Three hundred twenty-five cases came from a well-defined area and were used for incidence analyses. During the whole period of investigation, the disease was more common in men than in women. The difference was more pronounced in the earlier years of the investigation and among patients living in the country compared with patients living in the city. The mean age at onset of slipping has decreased in men from 16.0 to 12.7 years and has decreased in women from 12.6 to 11.8 years since the beginning of the century. The left hip is affected more often than is the right, especially in men, but during the past decades there has been a tendency toward equalization. Bilateral slipping was evident in 25.4% of the men and in 17.7% of the women. Men living outside the city were at higher risk for bilateral involvement than were men living in the city. In women, the situation was the opposite. The incidence has followed a periodic pattern with peaks approximately every 20th year. The mean incidence (number of cases/10,000 living born) during the period of growth was 6.1 in men and 3.0 in women. The maximal risk is supposed to be 25.7 in men and 20.5 in women. Men living in the country have always been at higher risk compared with men living in the city. Since the fifties, the incidence in women has also been higher in those living in the country. In women, the incidence was significantly higher between May and August. No seasonal variations were seen in men.
In 1994 a cerebral palsy (CP) register and healthcare programme was established in southern Sweden with the primary aim of preventing dislocation of the hip in these children. The results from the first ten years were published in 2005 and showed a decrease in the incidence of dislocation of the hip, from 8% in a historical control group of 103 children born between 1990 and 1991 to 0.5% in a group of 258 children born between 1992 and 1997. These two cohorts have now been re-evaluated and an additional group of 431 children born between 1998 and 2007 has been added. By 1 January 2014, nine children in the control group, two in the first study group and none in the second study group had developed a dislocated hip (p
To describe gender difference in a total population of children with cerebral palsy (CP), related to subtype, gross and fine motor function, and to compare CP incidence trends in girls and boys.
All 590 children with CP born in southern Sweden 1990-2005 were included. CP subtype was classified according to the Surveillance of Cerebral Palsy in Europe, gross motor function according to Gross Motor Function Classification System (GMFCS) and manual ability according to Manual Ability Classification System (MACS). Trends in CP incidence by birth year were analysed using Poisson regression modelling.
There was a male predominance in all levels of GMFCS except level II, in all levels of MACS and in all CP subtypes except ataxic CP. There was no statistically significant difference between males and females regarding gross motor function or manual ability. The CP incidence trends in boys compared with girls did not change during the period 1990-2005.
No equalization was detected in the incidence of CP between girls and boys during recent years in this total population. We could not confirm any consistent sex difference in motor function levels. Male sex is a risk factor for CP.
A long-term follow-up of 49 patients with an average age of 38 years (range: 25-67 years) who had experienced infantile Blount's disease was done. Thirty-seven patients had bilateral disease, giving a total of 86 affected knees. Thirty-eight knees had conservative or no treatment during childhood; 13 were treated by epiphysiodesis, and 35 by osteotomy. At follow-up, 11 knees showed arthrosis, and 9 were graded as mild. Ten knees had been surgically treated by medial meniscectomy at an average age of 29 years (range: 19-45 years), after the diagnosis of Blount's disease. Four of the knees showed arthrosis. Most of the patients had a straight leg and mild or no pain from their knee. It is concluded that most children with infantile Blount's disease will, at the age of 40 years, have a straight leg without arthrosis and that one third can reach this result without any treatment.
At the Department of Orthopedics of University Hospital, Lund, Sweden, cancer incidence and overall and cause-specific mortality were studied in a prospective cohort of 677 women who had experienced a fracture of the distal forearm in 1974 or 1975. The women were followed through population-based population, cancer, and death registries in southern Sweden. There was a significant reduction in overall cancer incidence (66 cases observed vs. 90.21 expected), breast cancer incidence (11 cases observed vs. 20.31 cases expected), and incidence of tumors of the female genital tract (5 cases observed vs. 11.84 expected). Overall mortality was also reduced (146 cases observed vs. 191.69 cases expected), and rates of death from circulatory disease (79 cases observed vs. 111.49 expected) and malignant tumors (30 cases observed vs. 40.41 expected) were both lower than expected.
The gross motor function and disabilities in children with cerebral palsy in southern Sweden were investigated and related to clinical features. The study covered the birth year period 1990-1993 and comprised 167 children, 145 of them born in Sweden and 22 born abroad. The clinical features and gross motor function were analysed at a mean age of 6.8 y. Clinical features were obtained from a continuing healthcare follow-up programme. Gross motor function was classified according to the Gross Motor Function Classification System (GMFCS). Walking independently was possible for 86% of the hemiplegic, 63% of the pure ataxic, 61% of the diplegic and 21% of the dyskinetic children. None of the tetraplegic children was able to walk. The classification of gross motor function revealed that 59% of the children were categorized into levels I and II (mildly disabled), 14% into level III (moderately disabled) and 27% into levels IV and V (severely disabled). Children born abroad were more severely disabled. CONCLUSION: The standardized age-related classification system GMFCS enabled a specific description of gross motor function in relation to clinical features. Significant differences between GMFCS levels and subgroups of diagnosis, aetiology. intellectual capacity, epilepsy and visual impairment were found.
The prevalence, clinical features and gross motor function of children with cerebral palsy in southern Sweden were investigated. The study covered the birth year period 1990-1993, during which 65,514 livebirths were recorded in the area. On the census date (1 January 1998), 68366 children born in 1990-1993 lived in the area. The study comprised 167 children, 145 of them born in Sweden and 22 born abroad. The livebirth prevalence was 2.2 per 1,000, and the prevalence including children born abroad was 2.4 per 1,000. The distribution according to gestational age, birthweight and subdiagnoses was similar to that in earlier Swedish studies, except for a higher rate of dyskinetic syndromes in this study. CONCLUSION: The point prevalence of cerebral palsy was 2.4 and the livebirth prevalence was 2.2. Children born abroad had a higher prevalence and were more often severely disabled. Severe disability was often combined with associated impairments such as mental retardation, epilepsy and visual impairment.