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PubMed1983

Apparent or true neonatal hip dislocation? Radiologic differential diagnosis.

A case of neonatal separation of the proximal femoral epiphysis secondary to obstetric trauma is presented. The radiologic differential diagnosis, as in other cases of neonatal dislocation of the hip, included congenital and septic dislocation of the hip and epiphyseal separation - so-called apparent dislocation. When clinical and laboratory signs are minimal or equivocal, x-ray films and, in difficult cases, contrast arthrograms are needed for an accurate diagnosis of neonatal dislocation of the hip.

Arthritis, Infectious↗
PubMed1992

Reduction of a nonconcentrically relocated hip dislocation in a seven-year-old boy.

Traumatic dislocation of the hip in childhood is a rare injury. Treatment usually consists of a closed reduction and some form of immobilization. Inability to obtain a concentric reduction by closed means is commonly attributable to soft-tissue interposition. This is a report of a method not previously described for obtaining reduction of a nonconcentrically reduced traumatic hip dislocation without an open surgical procedure.

Arthrography↗
PubMed1995

Is computed tomography useful after simple posterior hip dislocation?

Recent articles and textbooks of orthopaedic traumatology recommend routine computed tomography (CT) scans after successful reduction of simple posterior hip dislocations. This is based on the belief that CT, even in cases with concentric reductions, may identify fractures or intraarticular loose bodies not apparent on standard radiographs. This study was conducted to assess the usefulness of CT after concentric reduction of simple posterior hip dislocations. The hospital database was searched for all traumatic hip dislocations in the past 4 years. Charts and radiographs were reviewed, and only patients with simple posterior hip dislocations (no acetabular or femoral head fractures) and a concentric reduction identified on plain radiographs were included. Twenty-three patients who met these criteria and had subsequent CT scans to evaluate the hip joint were identified. CT scans confirmed the concentric reduction in all patients. Three small occult fractures were identified, and no occult intraarticular loose bodies were found. CT findings did not alter the treatment plan for any of the patients studied. In this small group of patients, CT scanning was not useful after concentric reduction by plain radiography of simple posterior hip dislocations.

Adolescent↗
PubMed2000

A review of the treatment of hip dislocations associated with acetabular fractures.

Traumatic dislocation of the hip is an extremely severe injury. Although previously considered an uncommon lesion, it now is seen more often as a result of motor vehicle accidents. In most cases, dislocation of the hip is associated with fractures of the acetabulum, which ultimately can result in a higher incidence of complications than the complications observed in pure simple dislocations. Early recognition and prompt closed reduction of the dislocated hip constitute the cornerstone of proper treatment of this injury. Once the dislocation is reduced, definitive treatment of the acetabular fracture can be delayed to obtain a precise diagnostic evaluation. If surgical reconstruction of the acetabular fracture is indicated, it is done best in the first 10 days after the injury. A few patients in whom nonconcentric reduction, failed closed reduction, or impaired neurologic status occurs after reduction will require early open reduction and internal fixation of the fracture. Complications can be caused by the initial injury or by the treatment. Avascular necrosis of the femoral head, degenerative osteoarthritis, and heterotopic ossification are the main complications encountered in patients with unsatisfactory final results. Despite a perfect reduction of the hip dislocation and anatomic reduction of the acetabular fracture, a significant degenerative process of the hip is expected when the patient is assessed at long-term followup.

Acetabulum↗
PubMed1990

[Bilateral traumatic hip dislocation].

The bilateral hip displacements are discussed. We divide these injuries in posterior, anterior and in an equal bilateral luxations of the hip. All types are rare (120 cases found in the literature), after all most of them are posterior hip luxations. Immobilisation must be considered for eight weeks, partial weight bearing to week ten, after this period full weight bearing can be allowed. Discharge from the hospital after three months. The danger of arthroses and femoral-neck necroses in this bilateral injury is discussed.

Accidents, Traffic↗
PubMed2000

Knee injuries in traumatic hip dislocation.

Of 187 patients treated at the author's institutions for fracture and/or dislocation of the hip during a 10-year period (1985-1994), 46 patients (25%) with a knee injury on the same side as the hip injury were evaluated 6 months to 11 years after the initial accident (mean, 3.65 years). Thirty-nine patients (85%) had symptoms or clinical signs in the knee. Ligamentous injuries overlooked in the initial examination were found in seven patients. Knee injuries often accompany hip fracture and/or dislocation, and can be produced by direct or indirect trauma. A delayed diagnosis of such injuries may lead to their treatment in the sequela phase, which complicates the final outcome. Therefore, an exhaustive physical examination is recommended for patients with traumatic hip dislocation to detect potential injuries to the ipsilateral knee. Early diagnosis and treatment of such injuries greatly improve final outcome.

Acetabulum↗
PubMed1991

Treatment versus non-treatment of hip dislocations in ambulatory patients with myelomeningocele.

Thirty myelomeningocele patients with untreated hip dislocations who had functional quadriceps and good ambulatory capability were evaluated for hip pain, hip motion and sitting ability: they had no pain, good to excellent hip motion and no difficulty in sitting. Three were wheelchair-bound. Nine had a limb-length inequality requiring a shoe lift. They were compared with a similar series of 11 patients who underwent open reduction of a dislocated hip with a two-year follow-up. Two patients in this group had improved and three had worse sitting balance. Serious perioperative complications occurred in six patients. The authors conclude that surgical reduction of paralytic hip dislocations in ambulatory myelomeningocele patients is costly and offers little obvious benefit.

Adolescent↗
PubMed2002

Management of hip dislocation with postural management.

BACKGROUND: Hip dislocation in children with cerebral palsy has a well-documented history and morbidity. OBJECTIVE: This paper presents a retrospective study of children with bilateral cerebral palsy who had various postural management and its effect on hip deformity. The most widely accepted theoretical model of hip subluxation/dislocation is that an imbalance in muscle length and strength around the hip leads to acetabular dysplasia and consequent hip subluxation. Maintenance of muscle length and strength and loadbearing is therefore a logical prevention. Research on normal infants' postures has provided biomechanical data to form the theoretical basis of 24 h postural management equipment. METHODS: The notes and X-rays of 59 children with bilateral cerebral palsy from East and West Sussex and Oxfordshire were examined and measured to determine whether a relationship existed between postural management and the level of hip subluxation/dislocation. X-rays were measured using Reimers' hip migration percentage. Postural management support was divided into three groups for analysis. Category 1: use of a 24-h postural management approach using Chailey Adjustable Postural Support (CAPS) systems in lying, sitting and standing; category 2: two items of CAPS (either lying/sitting or sitting/standing supports); category 3: use of the CAPS seat only and/or any other postural supports. Hip status was recorded for analysis as both hips safe (under 33% migrated), or one/both hips subluxed. RESULTS: Children using 'All CAPS' before hip subluxation maintained significantly more hip integrity than other groups (chi2 P < 0.05). CONCLUSIONS: Postural management interventions have an important role in the prevention of hip dysplasia.

Adolescent↗
PubMed2004

[Surgical treatment of secondary hip dislocation in cerebral palsy].

The surgical treatment of secondary dislocation of the hip is one of the most challenging issues in cerebral palsy. The selection and application of adequate surgical techniques require an outstanding knowledge of pathophysiology in order to achieve a good outcome with minimal operative expenditure. The hips of cerebral palsied children show no pathological findings at birth. The dislocation of the hip is a secondary process, due to the influence of permanently deteriorating muscle dysbalances that first cause a decentration and finally result in a complete dislocation. Physiotherapeutic treatment supports the development of gait, muscle balance and weight bearing in the early childhood, however, severe hip dislocation can not be prevented with physiotherapy alone. Surgical treatment aims to prevent hip dislocation in order to maintain the ability to walk and to sit, and to avoid secondary skin ulcers. Soft tissue release is performed to neutralize muscle dysbalances. Progressive dislocation requires extended surgical treatment. The combination of soft tissue release, varisation osteotomy and acetabular osteotomy enable an adequate repositioning of the hip and have proved to preserve hips from reluxation. Palliative operations including soft tissue release in combination with angulation osteotomy, and proximal femoral head resection are restricted to failed reconstruction operations or severe luxations, and are performed to attempt pain reduction or the facilitation of perineal care. Surgical planning distinguishes patients able to walk from those who are unable to walk or to sit without support. The manifestation of cerebral palsy and the aim of adequate pain reduction and the maintenance of statomotoric abilities also have a great impact on surgical planning. The treatment of secondary hip dislocation in cerebral palsy is facilitated by the use of a graduated treatment concept with early preventive soft tissue release, extended reconstruction and optional palliative care.

Adolescent↗
PubMed1987

Transient simultaneous sciatic and femoral nerve palsy secondary to iliacus and gluteal hematomas following heparinization for pulmonary embolus in a patient with posterior hip dislocation.

Sciatic nerve palsy as a result of a posterior hip dislocation has been reported in the literature. Femoral nerve palsy as a result of a iliacus hematoma has also been documented. However, a simultaneous sciatic and femoral nerve palsy occurring after heparinization for a pulmonary embolus in a patient with a posterior hip dislocation has not been reported. This combined nerve palsy was found in a 64-year-old white woman who had been involved in a motor vehicle accident and sustained a posterior hip dislocation. This patient subsequently had a pulmonary embolism, was heparinized, and then developed a large iliacus and gluteal hematoma, resulting in a simultaneous sciatic and femoral nerve palsy. Without treatment, the patient regained motor and sensory of the sciatic nerve in a few days, and a gradual improvement of function of her femoral nerve was evident over several months.

Female↗