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A total of 36 patients (42 hips) with frank congenital hip dislocation were studied. The initial clinical and x-ray signs were evaluated according to the age at which the patient was first seen and treatment started.
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In 1975 we carried out a survey in Hong Kong to locate Chinese children with congenital dislocation of the hip. Analysis of the available records between 1960 and 1975 gave an observed incidence which was at least 10 times less than found in Caucasians. The age and sex distribution, radiographic findings and the left-sided predominance were similar to Caucasians with congenital dislocation of the hip. However, unlike Caucasian children, the Chinese presented with dislocation and not dysplasia. The mothers of children with congenital dislocation of the hip were compared with a control group with normal children to assess their use of the "Hong Kong" position, in which the children are carried on the back of their mother with their hips in a position of wide abduction. Since only half of the children in either group were carried in this manner, other factors must be responsible for the low incidence of congenital dislocation of the hip in southern Chinese.
The long-term prognosis after open reduction of neglected posterior hip dislocations is poor; as such, primary arthroplasty is recommended by a number of authors. We present a patient with a 5-month-old posterior hip dislocation with concomitant paralysis of the sciatic nerve who had an open reduction. At a follow-up of 3.5 years, the patient has normal function with no signs of arthrosis. Magnetic resonance imaging scans, however, revealed partial avascular necrosis of the femoral head. A discussion based on the literature shows the uniqueness of this case.
We report on a radiographic screening programme at four months of age for infants who were clinically normal at neonatal examination but were considered to be 'at risk' for congenital dislocation of the hip because of their family history, breech presentation, or a persistent click. From a total population of 13,662 live births over a two-year period, 357 (2.6%) infants at risk were identified. Of these 46 had abnormal radiographs (six subluxations, 40 acetabular dysplasia). In 12 infants treatment resulted in a normal hip; 34 required no treatment but were followed up until their radiographs were normal and walking had begun. Of the 311 infants with normal radiographs, 256 (82%) were examined after 15 months of age; none had any detectable abnormality. We suggest that radiography of the hip at four months is a valuable adjunct to neonatal screening for infants at increased risk of congenital dislocation of the hip.
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An orthopaedic syndrome that apparently had not been reported previously was identified in twenty-three children. Characteristics shared by all twenty-three children included Hispanic descent, residence in Puerto Rico, bilateral dislocation of the hip, dislocated radial heads, short stature, and other osseous anomalies. Twelve dislocated hips in six patients were not treated. All of these hips were functioning satisfactorily at the time of the review, but only four of the children had reached skeletal maturity. Sixteen hips in eight patients remained reduced after closed reduction. Of these eight patients, the four who were skeletally immature at the time of the review had a satisfactory result, and the four who were skeletally mature had an unsatisfactory result because of discomfort or fibrous ankylosis. Eighteen hips in nine patients were treated with a reduction augmented by some form of operation. All of these hips redislocated. Of the forty-six elbows in the twenty-three children, thirty-three were dislocated, as seen clinically and radiographically; eight were normal, both clinically and radiographically; and there was dysplasia at the radiocapitellar articulation of the remaining five. Twenty of the twenty-three children were found to have carpal coalitions. Fourteen children had scoliosis, and five of them were managed with spinal arthrodesis and correction. Three patients had an anomaly of the cervical spine, with one deformity causing symptoms and signs that were treated with decompression. Eight patients had talipes cavus bilaterally, which was not treated.
Traumatic dislocation of the hip joint is relatively uncommon in children. The trauma required to produce a dislocation can vary from minimal to severe, high-energy force. We report a case of posterior hip dislocation in a 9-year-old boy who received relatively minor trauma to his leg but who did not seek medical attention for more than 24 hours. The child's hip was reduced without significant sequelae. Delay in reduction greatly increases the likelihood of later complications, including avascular necrosis of the femoral head.
We report on the application of hip arthroscopy to remove an osteochondral fragment created by a posterior hip dislocation. Preoperative and postoperative radiographs and computed tomography scans correlate with intraoperative arthroscopic photographs and are presented with this report. Arthroscopy allowed excellent visualization of the joint and facilitated straightforward removal of the fragment. We were able to avoid the larger incision required by an arthrotomy and decreased the patient's overall morbidity from this condition.
Thirty-four cases of unreduced congenital dislocation of the hip were reviewed. The hips were completely dislocated and rode high with the femoral head supported by gluteal muscles, but not by a false acetabulum. The mean Harris hip score was 64 points. Twenty-four patients (80%) had mild or severe low backache, and this was associated with increased lumbar lordosis or functional scoliosis. Seven patients (20%) had valgus malalignment and dysfunction of the knee joint. In older patients over 50 years old, there were many significant problems in the hip, lumbar spine and knee.
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We studied the outcome of ultrasound-monitored Pavlik harness treatment of 47 infants (nine boys and 38 girls) with 55 frankly dislocated hips documented by dynamic ultrasonography. The success and failure groups were of similar ultrasound status (hip-status score) at the time of initial examination, but a significant difference emerged at the 7- and 14-day examinations. Detection of frank dislocation and institution of treatment with the Pavlik harness within 3 weeks of birth increased the probability of a successful result. Of 33 infants (27 girls and six boys) with 41 dislocated hips who were seen before the age of 21 days, 26 (63%) hips were reducible in the Pavlik harness alone, and 15 (37%) hips were irreducible and required a subsequent procedure to achieve reduction. Fourteen infants (three boys and 11 girls) with 14 dislocated hips were first seen after the age of 21 days. Three (20%) were successfully treated in the Pavlik harness alone, and 11 (80%) required further treatment. In our opinion, persistent dislocation without improvement after 3 weeks of treatment in the Pavlik harness mandates discontinuation of use of this device. No anatomic factors were seen at the time of the initial ultrasound examination that permitted prediction of those hips likely to succeed or fail treatment with the Pavlik harness.
The prevalence of congenital dislocation of the hip in the Cree Indian population of Canada is very high. On 3 separate occasions, from 1973 to 1976, the author had the opportunity to conduct 3 missions in Quebec Northern Territories with the objective of training the medical personnel for carrying out examination of the hips in the neonatal period for the early diagnosis of congenital dislocation of the hip and the application of simple and efficient methods of treatment. The author reports his observations on the use of the tihkinakan cradle board, the high incidence of ligamentous hyperlaxity and how it may affect the clinical findings, the result of treatment of the older child and the clinical and radiological findings of the untreated dislocation in the adults. Most dislocations of the hip in the Cree Indians are now diagnosed early and a large number of them treated locally with braces and harnesses.
A 5-year-old girl with bilateral traumatic hip dislocations neglected for 6 weeks was successfully managed by skeletal traction for reduction and cast immobilization for 6 weeks. The delay in reduction did not preclude a good result. Osteoporosis of the femoral head was noted to be a favorable prognostic sign relative to its vascularity. Skeletal traction is an optimum method of reduction for neglected hip dislocations, while open reduction is rarely indicated. Prolonged restriction of weight bearing is unnecessary following soft-tissue healing.
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