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An unusual combination of posterior hip dislocation with ipsilateral femoral neck and head fractures is reported. The femoral head migrated too far inferiorly in the posterior part of the thigh, making it different from the previously reported solitary case report of obturator hip dislocation associated with femoral neck and head fractures.
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We report a 33-year-old trader with bilateral traumatic anterior hip dislocation following a road traffic accident. Both hip dislocations were reduced under general anesthesia followed by immobilization of the hips with skin traction. He discharged himself against medical advice one week after injury.
It seems obvious that congenital hip dislocation is determined by perinatal factors that are all the more "pathogenic" that the baby presents laxity (female sex or family laxity of the joints) and the hip is less mature (hereditary factor?). In our population, at the time of birth less than one child out of 1000 presents a dislocated hip that can be reduced (typical standard Ortolani sign). One or two percent present unstable hips that stabilize spontaneously in most cases. This stabilization can be expedited by correct diapering in abduction or may be hindered by such practices as wrapping infants from birth with their legs stretched and adducted, strapping the baby to a cradle-board, or perhaps even by putting the child to bed on its side. Stabilization may even be hindered by spontaneous asymmetrical postures that maintain the hip of the concave side of the baby in adduction, as in the pelvic obliquity syndrome of the newborn. The remaining children have a so-called stable hip which presents a variable degree of laxity on clinical examination and a variable degree of maturity on ultrasonography. The observation of established congenital dislocations in children who have been followed since birth (and such cases escape the most meticulous screening) suggests that in some hips there is no clear-cut dividing line between instability and laxity. Hips either stabilize or evolve into a fixed dislocation within the first three months, whereas it is only during the fourth month that X-ray examination may confirm the normality of such at-risk hips. Nevertheless, at that age, normality criteria are not very accurate.(ABSTRACT TRUNCATED AT 250 WORDS)
A case of a patient with traumatic, simultaneous right posterior and left anterior hip dislocations without associated fractures is reported. Simultaneous asymmetric bilateral hip dislocation is very rare. The mechanism of this injury is discussed.
Impaction fractures of the femoral head following anterior hip dislocation were noted in eight of 11 patients. This fracture is characterized by a depression or a flattening of the posterosuperior and lateral portion of the femoral head. It is usually seen on the standard anteroposterior view of the pelvis.
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Simultaneous anterior and posterior hip dislocation is an unusual injury. A unique case is presented, consisting of bilateral asymmetric hip dislocation with associated femoral head, femoral shaft, and acetabular fractures resulting from a motorcycle collision. The mechanisms of injury, management, role of imaging, and complications of this injury complex are discussed, with a review of the relevant literature.
The late results of 101 cases of avascular necrosis in congenital dislocation of the hip are reported, which occurred after closed reduction between 1954 and 1960. A good development of hips was observed in 24 cases (23,8%). A severe deformity took place in 33 hips (32.7%), which mostly had total femoral head necrosis. In the groups with partial necrosis a good development was occurred only in the half of all cases. Early treatment led to better results. Besides the necrosis the grade of luxation plays an important role for the development of the hips.
We studied coxa magna after operative treatment of congenital dislocation of the hip, including incidence, relationship to treatment, and influence of coxa magna on the acetabulum. Coxa magna was defined as a femoral head with a horizontal diameter at least 15% greater than the symmetrical position on the opposite side. Coxa magna developed in 16 hips (33%). The mean increase was 20.9% (range 15-30%). Three factors correlated with coxa magna: femoral osteotomy (100%), open reduction (75%), and operation at a younger age (mean 15.6 vs. 35.8 months). Four of the 16 hips developed coxa magna following Type 1 avascular necrosis; no other growth deformities appeared. At follow-up, the acetabular indices and the center edge angles were not statistically different between the coxa magna and the control groups. One must avoid confusing coxa magna with hip subluxation or inadequate reduction, of which the latter requires appropriate treatment. Coxa magna gives a good hip if a concentric, congruous reduction is obtained, providing the acetabulum has enough growth potential for remodeling.
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Numerous and various devices are being used in the treatment of congenital dislocation of the hip before the age of 1 year. We prefer the abduction pillow of Becker, owing to the simple design and use; there is also an economical factor: everybody can afford it. The abduction pillow can in no way be used for prevention. Only pathological hips with clinical signs confirmed by X-ray or sonography justify this treatment. Because of the good tolerance and efficacity of the pillow, it is the first choice treatment for unstable and luxated hips before the age of 4 months. If hips are not centered, other procedures should be used, in particular the Pavlik harness.
Of 103 neonates with congenital dislocation of the hip in a consecutive personal series, 100 were treated with a standard divaricator splintage regimen; of these, the result is known in 97. In three babies with irreducible dislocation no treatment was attempted. In 90 babies the hips became normal. In one hip dislocation persisted; in three osteochondritis with femoral growth plate damage developed without obvious cause; and in two hip dysplasia responded to surgical correction of femoral anteversion. In one baby attempted treatment of irreducible hips produced a poor result. The practice of treating all hips found to be unstable at orthopaedic examination but not those previously suspected but later unconfirmed is defended.
To determine the rate of late diagnosis of hip dislocations in infants, 26,455 newborns were examined by or under the supervision of the authors from 1976 to 1988. The incidence of examinations positive for dislocated or dislocatable hips was 3.8/1,000. The incidence of known late cases was 4/26,455 (0.2/1,000). Because follow-up of all initial examinations was not possible, this rate is probably artificially low. Hip screening programs with direct pediatric orthopaedic supervision can be successful, but late cases will still occur.
The aim of this paper was to determine the mechanisms of development or manifestations of the congenital dislocation of the hip by the method of multivariate analysis. The source of information were the family data about 300 children with congenital dislocation of the hip aged from 3 months to 15 years who had not been specially selected from those treated at the Centre and 300 children of the same age from unselected population. All the examinees were Georgians by nationality. Clinical methods of examination were employed. The results of the cluster analysis showed that the system of prognostic signs of the congenital dislocation of the hip consisted of 13 clusters in the experimental group (4 independent and 9 correlated) and of 13 clusters in the control group (5 independent and 8 correlated). The signs under investigation comprised the following groups of probable factors of the congenital dislocation of the hip: social-biological, geographical, obstetrical-gynecological, risk factors during the pregnancy, risk factors during the child birth on the mother's part, risk factors on the child's part, perinatal factors, postnatal factors, abnormalities of the child and its relatives. The obtained system of prognosis is well agreed with the biological mechanisms of the congenital dislocation of the hip. These data may be used for making perinatal and preclinical diagnosis, for raising the efficiency of medicogenetic consultations and for the initial orthopaedic prevention of the disease.
36 children (61 hips) who had nonoperative treatment of developmental hip dislocation with the Frejka pillow and developed avascular necrosis were followed-up for an average of 20 (17-26) years. The radiographic pattern of necrosis was classified into 5 types. At final follow-up after completion of growth, the radiographic outcome was excellent in 11 hips, good in 21, fair in 19, and poor in 10 hips. There was a close correlation between the pattern of necrosis and the outcome: all the poor results were observed in cases with changes also involving the metaphysis.
This prospective observational study aimed to determine the rate of success of reduction of dislocated hip prostheses using conscious sedation. In 101 consecutive patients presenting to the emergency department between August 2000 and February 2003 with a dislocated hip prosthesis, reduction was attempted using conscious sedation. The outcome measures of the study were (a) rate of success of the attempted reductions (b) rate of complication of the sedation or the procedure, and (c) rate of success in the three subgroups (based on degree of dislocation). The overall success rate was 62% (95% CI 53% to 71%). There were six complications: five related to sedation and one was a mild foot drop. The mean time to attempted reduction using conscious sedation was 1.83 hours and for an equivalent group who were excluded and subsequently required general anaesthesia the mean time was 10.9 hours. Reduction of isolated unilateral prosthetic hip dislocation using conscious sedation in the emergency department is safe and has a reasonable success rate. Prosthetic hip reduction can be attempted more quickly using conscious sedation than when awaiting general anaesthesia.