Congenital dislocation of the hip

In surgical skin planing steel wire brushes have been largely replaced by the less hazardous diamond chip burs or "fraises" and serrated steel wheels. In addition to acne pits and wrinkling, multiple actinic (senile) keratoses are an important indication for planing. Planing provides a nonscarring method for the treatment of existing keratoses, as well as a prophylaxis against skin cancer by replacing the sun-damaged, precancerous epidermis with new epidermal cells derived from the cutaneous adnexa (pilosebaceous and sweat gland units). There are clinical landmarks indicating the depth of planing which can serve as a guide to the operator and can be correlated with microscopic findings. The results of experiments on the comparative effects of refrigerants on animal and human skin indicate that human facial skin can tolerate considerable freezing with ethyl chloride or dichlorotetrafluoroethane (Freon 114) but that mixtures containing large proportions of the much colder dichlorodifluoromethane (Freon 12) may be undesirable. Refreezing an area of the skin in order to perform a more adequate planing is not considered hazardous.THE REGENERATION OF THE SKIN FOLLOWING PLANING HAS THREE COMPONENTS: Epidermal, adnexal and dermal. The cells of the epidermis and the adnexa are equipotential. A knowledge of the anatomy of the acne pit enables the operator to decide which pits can be benefited by planing and which should be excised before planing. The successful treatment of acne pits of the face by planing in patients having keloids elsewhere on the body is reported.     

Neonatal screening in Vancouver for congenital dislocation of the hip.

After 20 years'' experience throughout the Western world the effectiveness of screening newborns for congenital dislocation of the hip remains controversial. Is the clinical test for hip instability (the Ortolani or "jump" sing) reliable? Are other equally important physical signs frequently missed by inexperienced examiners? Do some dislocations develop after the newborn period when no abnormality was identifiable during the first week of life? In Vancouver, screening for this condition was initiated in 1964. In the 5-year period 1967-1971 an orthopedic surgeon screened all the infants in the newborn nursery of one hospital, while orthopedic residents screened all those at another hospital. Their rates of neonatal and late (after the first month of lfe) diagnosis of congenital hip abnormalities were, respectively, 6 and 0.3/100 lives births for the surgeon and 5 and 0.8/1000 for the residents. In contrast, at 20 hospitals that did not have regular screenign the average rates were 1.2 and 1.4. Systematic screening the early treatment have great potential for reducing the need for immobilization and surgical treatment of infants who congenital dislocation of the hip is missed in the first month of life. it may also prevent the arthritic sequelae that in adult life afflict many patients whose treatment was begun after the newborn period.     

Difficulties in diagnosing and managing congenital dislocation of the hip.

In a 10-year retrospective study of 25 921 consecutive deliveries in a neonatal unit in Newcastle upon Tyne 271 cases of congenital dislocation of the hips were identified. Of these, the outcome was unsatisfactory in 12: four diagnoses were missed at birth and eight children required further surgical treatment. Radiological abnormalities were detected in a further five children at long-term follow-up examination. From the results of this study and other published series it was concluded that lack of attention to detail was the main cause of inadequate diagnosis and management of congenital dislocation of the hips. More detailed instruction of junior staff, confirmation of the diagnosis by senior staff, the use of a non-removable splint early in treatment, and thorough follow-up by senior staff are all important.