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PubMedDate not supplied

Hip dislocation and subluxation in cerebral palsy.

Four hundred sixty-four patients with cerebral palsy were reviewed. They were placed in four function groups: independent ambulators (n = 76), dependent ambulators (n = 43), independent sitters (n = 41), and dependent sitters (n = 304). The percentage of subluxated or dislocated hips increased from 7% for independent ambulators to 60% for dependent sitters. In the dependent sitters, a level pelvis or different degrees of pelvic obliquity did not correlate with whether the hip was located, subluxated, or dislocated. The subluxated or dislocated hip did not correlate with the high side or the amount of pelvic obliquity. Muscle imbalance around the hip and not the pelvic obliquity is the cause of the hip subluxation or dislocation.

Adolescent↗
PubMedDate not supplied

[Salter's pelvic osteotomy in the treatment of congenital hip dislocation and hip dysplasia with special reference to pelvic tilt].

On the basis of 63 Salter pelvic osteotomies which were performed in 57 patients with congenital dislocation and subluxation of the hip between 1970 and 1986 at the Orthopaedic University Clinic of Vienna, we tried to work out the reasons for the rate of failures of 29% in our material. The mean age at operation was 4.1 years (1.5-18), that at follow up 15.7 years (4.6-28). We based our assessments on the clinical and radiological criteria of the Commission for the Study of Hip Dysplasia of the German Society of Orthopaedics and Traumatology. The number of failures at follow up (hip value III + IV) increased from 25%, if the operation was done before the age of four years, to 41%, if it was performed at a later age. In the latter group we were not able to observe any spontaneous improvement, which was typical for the younger age group. A moderately pathologic hip dysplasia (hip value III) could be improved to a normal value at follow up in 87%, an extremely pathologic one just in 50% of the cases. In just some of the patients we found postoperatively a tilt of the distal pelvic fragment, which could be registered by the oval shape of the foramen obturatum. Above all in young children a pelvic tilt was rare because of the elasticity of the triradiate cartilage. Out of 37 evaluable cases a tilt of the distal pelvic fragment by the operation could be verified in only 12 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[The influence of ultrasonography on the diagnosis and treatment of so-called congenital hip dislocation].

By means of a retrospective analysis of the hospital reports of 107 children with 131 dislocated hips we investigated the influence of ultrasound examination on the diagnosis and therapy of congenital dislocation of the hip. We could show, that although the ultrasound examination had increased since 1985 the number of dislocated hips receded only little. However the diagnosis was made earlier in children who had been examined by ultrasound. In these children operative reposition of the dislocated hip had to be performed less frequently compared to the unexamined children. Several case reports are given to demonstrate typical faults in ultrasound diagnostics and treatment of congenital hip dislocation. Our results support the call for a general ultrasound screening of the newborn hip.

Age Factors↗
PubMed1979

[Value of the orthopedic examination of newborn infants with regard to the diagnosis of hip dislocation].

Out of a total of 10,617 new-born babies examined, 11.1 percent required supervision as a result of clinical signs pointing to a congenital dislocated hip joint, and 6 percent as a result of anamnestic indications. X-ray follow-up examinations after four months showed pathological hip joint findings in 27.7 percent of the patients under supervision. Out of a total of 1,587 new-born babies without pathological findings (both clinical and anamnestic), 1.2 percent showed pathological hip findings in an X-ray examination performed at the age of four months. The overall incidence of congenital dislocated hip joints was found to be 5.8 percent. The results point to the importance of regular and thorough hip examinations in child-welfare centers even after earlier checks on new-born babies which revealed no pathological findings.

Follow-Up Studies↗
PubMed1975

Pelvic displacement osteotomy for chronic hip dislocation in myelodysplasia.

Twelve children with lumbar-level myelodysplasia (average age, eight and three-quarter years) underwent twenty-one pelvic displacement osteotomies for subluxated or dislocated hips. Nineteen of the twenty-one hips remained reduced on three-year follow-up. Gains in gait pattern, ease of bracing, and reduced pelvic obliquity were noted. Active function about the hips was not improved, nor was there a decrease in the amount of bracing needed following the osteotomy. Pelvic displacement osteotomy can be utilized in selected cases as part of the over-all management of chronic hip dislocation in myelodysplasia.

Adolescent↗
PubMed2006

The role of the ossific nucleus in the treatment of established hip dislocation.

UNLABELLED: Timing the reduction of a delayed presenting dislocated hip is controversial if the ossific nucleus of the proximal femoral epiphysis is absent. We formulated a decision model for management of 6- to 13-month-old infants based on two strategies: waiting for the ossific nucleus to appear before reducing the hip or immediate reduction. The model included the occurrence of long-term physical disability within a period of 20 years. A literature synthesis provided outcome probabilities. Outcome was measured by utilities derived by content experts. Waiting for the ossific nucleus was the preferred strategy with an expected value of 0.95 as opposed to 0.86 in the immediate reduction strategy. Sensitivity analyses showed the model was robust. Based on the results of decision analysis, reducing a dislocated hip in the presence of the ossific nucleus is likely to be the better strategy if avascular necrosis and long-term disability are considered. The difference between the two strategies is equivalent to one quality-adjusted life year, which is substantial. LEVEL OF EVIDENCE: Economic and Decision Analyses, Level II-1. See the Guidelines for Authors for a complete description of levels of evidence.

Age Factors↗
PubMedDate not supplied

[Evaluation and prognosis of changes in the femur end of the hip in hip dislocation].

Long-term observations proved the necessity of careful control of the development of femur head epiphysis in case of dislocated hip joint. The occurrence of femur head necroses can be greatly reduced by a sparing functional treatment. Endogenously conditioned constructive disturbances, which can be found in 5 to 7 p.c. of all cases, have to be clearly distinguished from head necroses.

Child↗
PubMed1997

[Hip dislocations and hip fractures--acetabular fractures. Indication, technique and results of conservative treatment].

Despite the great number of publications during the last 10 years concerning the indication, technique and results of operative treatment of acetabular fractures, conservative treatment still has an important role when considering the therapeutic possibilities. Because of the modern techniques of radiological imaging and improvement of diagnostic facilities, a more defined indication for treatment becomes possible. Conventional X-rays, completed by special projections like the Ala and Obturator view, and a CT scan allow determination of the fracture type (the Letournel/Judet classification or the AO classification). The most suitable treatment can then be adapted to the individual circumstances of the patient, i.e., age, general condition and overall severity of traumatic impairment. Determination of the intact part of the weight-bearing dome is important in selecting the most adequate therapeutic procedure. The larger the intact roof arc, the better the prognosis. Together with the X-ray controls following axial and facultative lateral extensions, the indication for conservative treatment can be confirmed. Early active motion of the injured limb, followed by walking exercises with partial weight-bearing, are important aspects of nonoperative treatment. Conservative treatment is recommended in non-displaced fractures or in fractures with little displacement, transverse fractures of the lower region or severely comminuted acetabular fractures with no possibility of reconstruction. Our clinical and radiological follow-up of 97 patients with acetabular fractures from the years 1981-1990 showed that the majority were treated conservatively (approx. 70%). The functional result after an average observation period of more than 70 months was good or excellent (based on the Merle d'Aubigné score). We feel it is important to look at operative and conservative treatment of acetabular fractures as two complementary non-competitive therapeutic methods. The choice of treatment should be based on an exact diagnosis considering fracture type, the individual circumstances of the patient, and application of the necessary diagnostic facilities. Conservative treatment can lead to excellent long-term results.

Acetabulum↗
PubMed1998

Surgical management of hip dislocation in children with arthrogryposis multiplex congenita.

Arthrogryposis multiplex congenita (AMC) is a rare disease with multiple joint contractures. It is widely believed that bilaterally dislocated hips should not be reduced since movement is satisfactory and open reduction has had poor results. Since 1977 we have performed a new method of open reduction using an extensive anterolateral approach on ten hips in five children with AMC. The mean age at surgery was 31.5 months (17 to 64) and the mean follow-up was 11.8 years (3.8 to 19.5). At the final follow-up all children walked without crutches or canes. Two managed independently, one required a long leg brace and two had short leg braces because of knee and/or foot problems. The clinical results were good in eight hips and fair in two and on the Severin classification seven hips were rated as good (group I or group II). We recommend the extensive anterolateral approach for unilateral or bilateral dislocation of the hip in children with arthrogryposis or developmental dislocation of the hip.

Acetabulum↗
PubMed2004

Operative treatment of bilateral hip dislocation in children with arthrogryposis multiplex congenita.

PURPOSE: Arthrogryposis multiplex congenita (AMC) is a rare syndrome with multiple joint contractures. It is commonly believed that bilaterally dislocated hips associated with joint contractures should not be reduced, because movement is satisfactory, while open reduction leads to poor results. This report presents our experience with surgical management of bilateral dislocation of hips in children with AMC. METHODS: During the period 1990 to 2000, we performed open reduction on 8 hips of 4 children with AMC. The mean age at surgery was 23 months (range, 5-48 months). Open reduction and capsular plication without any bony procedure were performed in 4 hips (2 patients). De-rotation and varus osteotomy of the femur was performed in 4 hips, and Salter osteotomy of the innominate bone in 2 hips. The average acetabular index was 44 degrees, and the mean centreedge angle was -41 degrees preoperatively. RESULTS: The average follow-up period was 4 years (range, 2-9 years). The average acetabular index and centre-edge angle were 19 and 18 degrees, respectively at the time of last follow-up. All children could walk without support. One child required re-opening for redislocation of hip joint. The clinical results were good in 6 hips and fair in 2 hips, according to Severin's and McKay's classifications. CONCLUSION: Our experience shows that open reduction for bilateral dislocation of hips in children with AMC is a suitable option with generally good results. Surgery performed at earlier age gives the best functional outcome.

Arthrogryposis↗
PubMed1993

A new method for reduction of hip dislocations.

Traumatic hip dislocations and dislocation of total hip arthroplasties are common injuries. Closed reduction of either a dislocated hip or a total hip arthroplasty can be a demanding procedure and may necessitate open reduction if unsuccessful or lead to further complications. These include fracture or neurovascular injury to the patient, as well as injury to the surgeon when reducing the hip. This article describes a technique that reliably reduces dislocations while minimizing complications.

Female↗
PubMed2001

Total hip replacement for the dislocated hip.

Replacing the dislocated hip is technically more challenging than replacing the subluxated hip. Overall, clinical and radiographic results have not been as good for hips that are completely dislocated. The surgical approach must allow for identification of the false and true acetabula, identification of the sciatic nerve, and lengthening of the leg. In patients with a dislocated hip who are managed with total hip replacement, coverage of the cup can be achieved by medialization, creation of a high hip center, or use of a structural graft. Bone grafting allows the cup to be placed in an anatomic position, provides bone stock for additional surgery, and restores leg length. Our results and the results of other authors confirm that these grafts remain intact for at least 10 years and restore bone stock for additional surgery. This is particularly important in this relatively young population.

Acetabulum↗
PubMedDate not supplied

Salter's innominate osteotomy in the treatment of congenital hip dislocation: a long-term review.

We reviewed 39 patients with 52 congenitally dislocated hips, all managed by open reduction and Salter's innominate osteotomy. Mean follow-up period was 13 years (range, 8 to 25 years); 78.9% of the hips had a good or excellent clinical result, and 71.1% were good or excellent radiologically. The patients who underwent Salter's innominate osteotomy before the age of 4 had better clinical and radiological results (88.4 and 81.4%, respectively). The radiographs of the unilateral normal hips were compared to the surgically treated hips according to their acetabular index angles, center-edge angles of Wiberg, and femoral neck-shaft angles. No statistical differences were found between these two groups. The Bucholz-Ogden classification was used for the diagnosis and classification of avascular necrosis. The late radiographic signs of types 2, 3, and 4 avascular necrosis were seen in 34.6% of this series. The results show that Salter's innominate osteotomy provides good lateral coverage of the femoral head. The results are better if the operation is performed between the ages 18 months and 4 years.

Age Factors↗
PubMed1989

Arthroplasty for congenital hip dislocation. Techniques for acetabular reconstruction.

We investigated a series of 63 arthroplasties for chronically dislocated hips or severe dysplasia with at least two thirds of the femoral head uncovered. Direct cementation into the neoacetabulum at the pelvic wing was followed by 6/20 revision arthroplasties and 3/20 impending failures. Cups supported by cortical bone grafts were revised in 8/16 and found loose in 2/12 arthroplasties. The best technique was restoration of the rotational center of the hip joint and roof reconstruction with a femoral head graft with 2/25 revisions and signs of loosening in 2/25.

Acetabulum↗
PubMed1987

Natural history of congenital hip dislocation (CDH) and hip dysplasia.

For normal development of the hip joint to occur, there must be a delicate, genetically determined balance between growth of the acetabular and triradiate cartilages and a well-centered femoral head. This balance may be profoundly affected by the intrauterine environment. Without treatment, it is uncertain how many dysplastic, unstable hips will retain their dysplastic features throughout life. The natural history of untreated complete dislocation varies considerably and is affected by societal considerations. There may be little, if any, functional disability in many cases. Significant roentgenographic degenerative disease and poor clinical results, however, may develop in completely dislocated hips with well developed false acetabulae. In unilateral cases, ipsilateral knee deformity and pain may develop. Congenital subluxations have a particularly poor long-term outcome. A significant percentage of these patients have roentgenographic degenerative joint disease and clinical disability. The age of symptom onset and roentgenographic degenerative joint disease is related to the amount of subluxation and dysplasia. The natural history of acetabular dysplasia in the absence of subluxation is difficult to predict. Physical signs may be absent, and the diagnosis only established with symptom onset or as an incidental roentgenographic finding. While degenerative joint disease may ensue, current roentgenographic parameters are not predictive.

Adult↗
PubMed2003

Open anterior-inferior hip dislocation.

Traumatic hip dislocations result from high-energy trauma. These dislocations are usually posterior in direction and have severe associated injuries. The less common anterior dislocation is usually of the inferior type. We report a case of an open anterior-inferior hip dislocation secondary to a high-speed motor vehicle collision. The wound was in the medial upper ipsilateral thigh. To our knowledge, this is the first reported case of an adult with an open inferior-type anterior hip dislocation.

Accidents, Traffic↗