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PubMed1978

[The inguinal incision for the open reduction of congenital hip dislocation (author's transl)].

Operative reductions of congenital hip dislocation are sometimes difficult when lateral incisions are used since the medial part of the acetabulum and the lower limbus are difficult to visualize. In the Ludloff technique this part of the acetabulum is seen excellent, but not the lateral part. High dislocations with inverted limbus are difficult to reduce and only with partial excision of the limbus. An inguinal incision beginning lateral at the spina ilica ventralis offers the best view and can be used for all different degrees of dislocation and age groups. The technique is described, the advantages and the rate of avascular necrosis compared with other incisions. Femoral osteotomies and acetabular or pelvic osteotomies should not be done at the same time because of a higher percantage of avascular necrosis. In high dislocaitons shortening osteotomies should not be done in the intertrochanteric region but deeper in the shaft to avoid additional disturbances of the vascular system of the proximal femur.

Femur Head Necrosis↗
PubMedDate not supplied

Treatment of the chronically dislocated hip in adolescents with cerebral palsy with femoral head resection and subtrochanteric valgus osteotomy.

Femoral head resection with valgus subtrochanteric osteotomy was performed on six hips in five nonambulatory adolescent patients with painful, chronically dislocated hips due to spastic paralysis. This procedure was successful because it led to pain relief, ease of perineal care, and facility of seating. Complications, such as proximal migration of the remaining femur, recurrence of adduction deformity, hip stiffness, and excessive heterotopic bone formation, common to other procedures used for this condition, have not occurred.

Activities of Daily Living↗
PubMed1997

[Injury classification and surgical approach in hip dislocations and fractures].

During the last few decades, traumatic injuries of the hip joint have significantly increased in number, and traffic accidents have also increased. Depending on the speed, direction of the forces and the position of the femur at the moment of impact, different patterns of injury occur. Basically, they are classified as hip dislocations, dislocation fractures and acetabular fractures. These injuries have in common a high rate of concomitant lesions. Several classification systems have been developed for these injuries. Commonly, Stewart and Milford's or Levin's classification is used for dislocations and dislocation fractures. For acetabular fractures, Judet and Letournel's classification and its newer version developed by Helfet (AO classification) are generally accepted. Fractures of the femoral head, though included in these classifications, are typically described by separate classifications like the one presented in 1957 by Pipkin. The multitude of injuries occurring in the hip joint requires vast knowledge of various operative approaches. No single approach exists that would permit the treatment of all injuries in an ideal fashion. Approaches are either considered limited (Kocher-Langenbeck, ilioinguinal iliofemoral) when they permit access only to a restricted segment of the joint, or extended (extended iliofemoral, Maryland, Ruedi) when they allow all-round visualization of the hip joint. The choice of the best approach for an individual patient depends on the type of injury and also on patient variables like age, preexisting disease, and concomitant injuries. The decision is further influenced by the timing of surgery, the kind of fracture stabilization intended and by complications typically seen with certain approaches. The indication for extended procedures is only seen in patients with complex injury patterns involving both the anterior and the posterior column or in delayed cases undergoing surgery more than 3 weeks after trauma. Extended approaches permit excellent visualization of the fracture, but the extent of the soft tissue trauma is reflected in a high rate of postoperative complications. After a phase in which extended procedures were favored, recently a trend towards more limited approaches can be recognized because of their lower complication rate. This is facilitated by modern fracture-reduction methods using indirect techniques.

Acetabulum↗
PubMed1989

[Several causes of complications of the surgical treatment of congenital hip dislocation].

The article is devoted to revealing of the causes of complications in children with congenital dislocation of the hip. 42 patients have undergone roentgenological, electrophysiological and neurological examinations; 32 of them had complications following surgical treatment of the dislocation of the hip. In the patients with complications disturbances in the structure of the lumbosacral section of the spine and neurological changes have been revealed. Reduced excitability of the motoneurons of the spinal cord has also been observed in these patients. In 10 children with satisfactory results the deviations in the structure of the lumbosacral section of the spine were insignificant, while gross neurological changes were not revealed. The authors have arrived at the conclusion that the main causes determining the results of surgical treatment are the initial state of the neuromuscular apparatus and dysplasia of the vertebral column structures. That is why in the patients with disturbances it is necessary to carry out adequate conservative therapy directed at improvement of the metabolism of the neuromuscular structures both before the operation and during the postoperative period, e.g. 2-4 times a year according to the expression of the neurological disturbances.

Adolescent↗
PubMed1997

[Congenital hip dislocation. Ultrasonic screening of newborn infants].

Despite the introduction of clinical screening and early treatment of congenital dislocation of the hip (CDH), the prevalence of subluxated/luxated hips in later infancy is still reported to be as high as 1-3 per 1,000 infants. Using ultrasound, it is possible to evaluate both hip morphology and hip stability. Hip morphology is best evaluated using Graf's coronal section through the deepest part of the acetabulum. Classification of the hips into different categories can then be based on measuring the angle of inclination of the acetabulum (alpha-angle) or femoral had coverage. Hip stability can be assessed by a Barlow-equivalent provocation test during the ultrasound examination. In the Norwegian newborn population approximately 85% of the infants have morphologically normal hips (based on the alpha-angle) while 12% have immature and 3% dysplastic hips. About 80-90% of infants with dysplastic acetabula show only minor changes, and many of the hips may normalize without treatment. Several studies indicate that universal ultrasound screening might reduce the occurrence of late diagnosed congenital dislocation of the hip.

Hip Dislocation, Congenital↗
PubMed1981

[Neglected hip dislocation fractures (author's transl)].

Follow-up of 30 patients with hip dislocation fractures showed avascular necroses in more than 30% of the cases and/or arthrotic changes and dissatisfying clinical results. In our opinion there is no sense in trying to reconstruct the joint by surgical procedures especially in elderly patients in cases with combined fractures, concomitant comminuted fractures of the femoral head and neck or destruction of the acetabulum. In all these cases we recommend a total hip prosthesis (elderly people) or in younger patients an arthrodesis immediately after the accident.

Acetabulum↗
PubMed1995

Is there a difference between the epidemiologic characteristics of hip dislocation diagnosed early and late?

OBJECTIVE: To determine if there are epidemiologic differences between patients with early and late developmental dislocation of the hip (DDH). DESIGN: A chart review. SETTING: A university-affiliated children's hospital. PATIENTS: Two hundred and forty-three children, 191 with early DDH and 52 with late DDH. MAIN OUTCOME MEASURES: Sex, side involved and prevalence of bilaterality. RESULTS: There were significant differences between the two groups with respect to side involved (p < 0.0002) and bilaterality (p = 0.006) but not in relation to sex. Left-sided dislocations were predominant in the early group and right-sided dislocations in the late group. Bilaterality was more common in the late group. CONCLUSION: There is circumstantial epidemiologic evidence that late DDH may be a different entity from early DDH.

Female↗
PubMed1990

[Results of the surgical treatment of congenital hip dislocation in schoolchildren].

The author presents his experience of surgical treatment of 63 high congenital dislocations of the hip in schoolchildren. Osteotomy of the pelvis after Salter in combination with shortening osteotomy and open reduction of the hip has been used. Aseptic necrosis of the femoral head in the postoperative period has been revealed in almost 80% of the cases; the results were good during the first 10 years of observations in 28.5% and bad in 31% of the cases; after 10 and more years the percentage of good results fell to 18%. However, the patients gave a higher estimation of the treatment results as the period of clinical compensation of the operated joints lasted 10 to 12 pears, which made easier their contacts with schoolmates and family creation in future.

Acetabulum↗
PubMed1992

[Functional treatment of central hip dislocation--personal modifications].

A slow, lasting for several hours method for reduction of central dislocation of the hip with the use of bidirectional traction, with Rush pin introduced in the trochanter major and Steinmann pin in supracondylar area, with 18 degrees of the lateral tilt of the bed, with standard upper frame of Gruca bed mounted laterally and great traction force against the hip is presented. The universal Gruca splint was employed in the after-treatment. In 12 patients with grade II and III central dislocation of the hip excellent early anatomical and functional results were achieved.

Acetabulum↗
PubMedDate not supplied

[Femoral head necrosis in hip dislocation and its prognosis (a literature review)].

In this article are discussed the classifications of avascular necrosis following treatment of congenital dislocation of the hip. The reported incidences of avascular necrosis according to the method of treatment are reviewed. The long-term follow-up and end results of conservative treatment of congenital dislocation of the hip with and without avascular necrosis have been analysed.

Femur Head Necrosis↗
PubMedDate not supplied

Posterior hip dislocation in a five-year-old boy: a case report, review of the literature, and current recommendations.

Traumatic hip dislocation constitutes a true orthopedic emergency, is a relatively rare occurrence in the pediatric population, and may be accompanied by minimal trauma. Long-term morbidity such as avascular necrosis or osteoarthritis of the femoral head may be significant if the diagnosis is not expeditiously confirmed radiographically and prompt reduction employed. A poorer prognosis is conferred by duration of dislocation for longer than 6 h, advanced skeletal maturity of the patient, severe joint injury, or multiple trauma in the affected patient. A case report involving traumatic hip dislocation in a 5-yr-old boy is described followed by a comparative review of the pediatric and adult literature with current recommendations.

Child, Preschool↗