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PubMedDate not supplied

[Complex reconstruction of subluxated and dislocated hip joints in spastically handicapped children].

QUESTION: Will surgical reconstruction of subluxated or dislocated hip joints in children with cerebral palsy lead to stable reduction and painless hips? Is there any positive influence on psychomotoric development of the children and on trunk and pelvic symmetry as well as on daily hygienic care after successful reduction of unstable hip joints in spastic children? MATERIALS AND METHODS: Thirty hip joints in 26 children with cerebral palsy were operated applying the same complex reconstruction method of the hip joint. Fifteen of these children with 17 operated hip joints fulfilled a minimum follow up period of 3 years were evaluated continuously in this study. The parents and physiotherapists answered a questionnaire, all patients were examined clinically and pelvic anteroposterior and lateral radiographs were obtained. RESULTS: The mean age at surgery was 6 years, the minimum follow up 3 years (3-10 years). All hip joints were preoperatively decentered, 6 subluxated, 11 complete dislocated. At follow-up 15 of 17 were persistently reduced. The postoperative results were graded by the parents as excellent and good in eleven, satisfying in four and in two patients as poor. The radiographic evaluation showed an significant improvement of the CE-, AC- and neck shaft angle. CONCLUSION: Reconstruction of decentered hips will lead to stable reduction and painless hips at least in mid term follow-up. Symmetrically centered hip joints are mandatory for a pelvic and spinal symmetry and may contribute for an optimal of psychomotoric development.

Cerebral Palsy↗
PubMedDate not supplied

Torticollis and hip dislocation.

Reports in the literature suggest that there is an association between two childhood disorders: torticollis, an easily recognized clinical deformity, and developmental dislocation or dysplasia of the hip, an occult disorder. The identification of the obvious disease, torticollis, may prompt a search for the occult disease, developmental dislocation of the hip. If the association of these two disorders is common, it may be justified to expend resources to diagnose the occult disorder in all cases in which the more obviously noticed disorder is recognized. The reported association varies between 2 and 29%. We retrospectively reviewed 70 patients with the diagnosis of congenital muscular torticollis to determine the incidence of hip dislocation or subluxation in these patients. Fifty-four patients had radiographs of their hips. Forty-one patients were available for follow-up at an average of age 3+4 years. Six patients were noted to have hip subluxation or dislocation, all at presentation. Of these, four had been referred for diagnosed hip disease, whereas two were referred for torticollis, and the hip disease was then diagnosed by the pediatric orthopaedist. No patient had abnormal radiographs or physical findings at follow-up. We conclude that the rate of hip disease in those with torticollis is approximately 8% and is lower than the 20% often quoted.

Child↗
PubMed1996

[Isolated hip dislocation of traumatic origin].

The final outcome following isolated traumatic dislocation of the hip that is reduced within 6 h is generally believed to be excellent. Forty-nine patients with an isolated dislocation of the hip were treated between 1974 and 1989 at the Department of Traumatology of the Hannover Medical School. The majority of patients were involved in traffic accidents, and 42 had associated injuries. All dislocations primarily treated at our hospital were reduced by closed methods within 3 h, (average 85 min, range 10-180 min), followed by early mobilisation with partial weight-bearing for 2-3 weeks. 42 patients were evaluated after an average follow-up period of 7.7 years. Radiological signs of partial necrosis were seen in two patients. Mild arthrosis was found in seven patients, moderate degeneration in two and heterotopic ossifications in four patients (two Brooker II, one Brooker III, one hip ankylosed). Twenty-nine of 33 MRI examinations were normal. Despite early reduction only 9/12 anterior and 14/30 posterior dislocations revealed excellent and good results according to the Thompson and Epstein classification. According to the present study the important prognostic factors are the direction of dislocation, the overall injury severity and the age at the time of injury.

Adolescent↗
PubMed1985

Open reduction of congenital hip dislocation. Advantages of the Ferguson medial approach.

Between 1974 and 1982, 56 hips of 51 children with congenital hip dislocation were treated by open reduction via the medial approach according to Ferguson. The mean age at operation was 7 (3-15) months. After 4 months of plaster cast immobilization, 41 hips had a normal acetabular index. Three hips required supplementary surgery: Salter's pelvic osteotomy in one case and a varus osteotomy in two cases. Of the remaining 53 hips, 26 received supplementary abduction treatment. During the first 2 years after reduction, 19 hips showed slight lateral displacement due to capsular laxity. The follow-up averaged 3 (0.5-8) years. All children older than 3 years now had stable, concentrically reduced hips without special treatment of the lateralization; in 9 of the 56 hips the acetabular roof was still dysplastic at follow-up. There was no difference in anteversion and neck-shaft angle between the treated and the contralateral hips. As vascular lesions were observed in only two hips and lateralization disappeared spontaneously, the Ferguson procedure seems safe.

Female↗
PubMed1982

Computed tomography in congenital hip dislocation. The role of acetabular anteversion.

Computed tomography usually can provide accurate documentation of the adequacy of a reduction in congenital dislocation of the hip. It should supplement other radiographic examinations when the status of a reduction is in question because the patient is wearing a plaster cast. The computed tomography scan provides a clear image of the reduction in the transverse plane, so that anterior or posterior subluxation of the femoral head can be easily detected. In addition it allows direct measurement of acetabular anteversion which previously had not been possible with non-invasive studies in the living patient. Radiation exposure is less than that for conventional tomography. We used computed tomography in five patients with congenital dislocation of the hip and our study provided new evidence concerning the role of acetabular anteversion in this condition. Acetabular anteversion was increased on the dislocated side in each patient, and returned to normal as treatment progressed.

Acetabulum↗
PubMed1986

Reduction of dislocated hip with transepiphyseal fracture.

A case report of a 12-year-old boy who suffered a dislocated hip in a football game. He was unable to walk and was in severe pain when seen in the emergency room. Efforts at closed reduction of the displacement were complicated by the development of a transepiphyseal fracture.

Athletic Injuries↗
PubMed1990

The effects of contact pressure elevations and aseptic necrosis on the long-term outcome of congenital hip dislocation.

The relationship between excessive articular contact pressure, aseptic necrosis, and the long-term outcome with unilateral congenital dislocation of the hip (CDH) was studied in a series of 84 patients treated by closed reduction and followed for an average of 29.2 years. Contact stress was estimated from archived radiographs taken at the time of maturity and at several follow-up visits. At a recent review, each patient was rated both clinically for pain and function and radiographically for deformity, degeneration, and aseptic necrosis. For each of 431 archived films, articular contact stress (force/area) was estimated mathematically, based upon a frontal plane equilibrium (force) analysis and a landmark-based inference of three-dimensional head surface (area). Good correlation with final deformity (Spearman rho = 0.78) was obtained when the hips were ranked in terms of a new cumulative overpressure index Pc, defined as a time-pressure product involving years of pressure exposure beyond a 2 MPa pressure damage level. An unsatisfactory outcome occurred in 90.4% of the hips experiencing Pc greater than 10 MPa-years (most of which had aseptic necrosis involvement), whereas the outcome was satisfactory in 80.9% of hips with Pc less than 10 MPa-years.

Adolescent↗
PubMed1993

Hip dislocation without fracture: traction or mobilization after reduction?

In all, 41 patients with traumatic dislocation of the hip, without associated acetabular or femoral fracture, were treated by two different methods after closed reduction, performed on average 2 h after injury. Patients in group A (N = 20) were subjected to skeletal traction for 2 weeks, followed by non-weight bearing for 3 months. Those in group B (N = 21) were mobilized a few days (average 9 days) after injury and allowed partial weight bearing. They were fully weight bearing at 3 months. The 31 patients were followed up for an average of 7.6 years and showed comparable long-term results in both groups. No early complications occurred in group B. There were no cases of avascular necrosis in either group. There were three cases of post-traumatic arthritis in group A and one in group B, and two cases each of heterotopic ossification. Early mobilization was concluded to be a safe and more comfortable method of after-treatment. Earlier return to work was a significant benefit in Group B.

Adolescent↗
PubMed1993

A case-control study of congenital hip dislocation.

In this study we have investigated various epidemiological factors which may be related to congenital dislocation of the hip (CDH). Eighty-one cases born during the period 1st January 1988 to 31st August 1990, with four matched controls per case, were identified from consultants' records held at the Queen's Medical Centre and City Hospital, Nottingham. One hundred and twenty-four subjects who were referred to a new Hip Instability Clinic with suspected CDH, but not diagnosed or treated for CDH, were also included as a third group. Information about the mother's pregnancy, previous medical history and family history was collected from obstetric records kept at the two hospitals. Multigravidae and similarly multiparous women had a statistically significantly reduced risk of having a baby with CDH. The relative risks were 0.55 (95% confidence interval 0.33, 0.93) and 0.53 (95% confidence interval 0.31, 0.91) respectively. The method of delivery was also of importance. Babies born by Caesarean section or in breech position had an increased risk of CDH which was statistically significant. Using addition clinical information obtained from subjects attending the Hip Instability Clinic we also found that cases were more likely to have a family history of CDH than subjects who were screened for CDH but found to be normal.

Breech Presentation↗
PubMedDate not supplied

[Surgical treatment of hip dislocation in patients with infantile cerebral palsy].

The results of 63 operations on 52 patients with cerebral palsy, which were performed between 1978 and 1988 to correct a subluxation or dislocation of the hip, were reviewed. The innominate pelvic osteotomy was preferably combined with intertrochanteric femoral osteotomy and soft tissue release. The average age at time of surgery was 7 years/2 months. Surgical intervention was indicated irrespective of the severity of neurologic involvement. The mean follow-up period is 3 years/4 months. The results show, that by a combinations of these surgical procedures a permanent stability of the hip joint can be achieved. Retrospectively the 5 cases of reluxation can be explained by insufficient surgical technique. The postoperative development of the CE-angle and the acetabular index reveal, that after adequate reduction of the femoral head the acetabulum is able to remodel its dysplasia. From a functional point of view actually patients with diplegia gained the most benefit from a stable hip joint, because they showed the most progress in motor activity. In tetraplegic patients the long-term success of these surgical procedures must be seen in the prevention of a painful hip in adult life, the maintenance of sitting-stability and the improvement of perineal care condition.

Adolescent↗
PubMedDate not supplied

[Etiology of hip dislocation in children with cerebral movement disorders and possibilities of conservative treatment using rotating and spreading plates and electrostimulation].

Dislocations of the hip associated with spastic paralysis are almost always found in severely disabled children. The onset is in infancy. Two methods, electrostimulation of the minor gluteal muscles and treatment with simple leg casts to correct the malposition, are described. Follow-up examinations showed that the treatment had had a positive effect on the hip condition in 33 of the 42 children treated with casts and 26 of the 32 children treated by electrotherapy. Electrotherapy is an innovation, since in the past it was considered contraindicated in these patients. However, it is based on the fact that the gluteal muscles do not normally show any spasticity. Irrespective of this, the treatment is long-term, and has to be continued for many years, a fact which makes greater demands on the cooperativeness of the family.

Adolescent↗
PubMed2002

The Ilizarov hip reconstruction osteotomy for hip dislocation: outcome after 4-7 years in 14 young patients.

Treatment of neglected high dislocation of the hip is difficult in adults. We performed hip reconstruction osteotomy, consisting of a proximal abduction and extension osteotomy, and a distal varisation and lengthening osteotomy, utilizing the Ilizarov external fixator in 14 (12 women) patients having a mean age of 20 (12-33) years. The most frequent preoperative complaints were pain, leg-length discrepancy, limping, reduced activity and limited abduction of the hip. After an average follow-up of 68 (55-81) months, the outcome was satisfactory; pain subsided in all patients, the Trendelenburg sign became negative in all but 3 patients, no patient had limb-length discrepancy, and alignment of the extremity was reestablished. However, 3 patients still complained of lurch.

Adolescent↗
PubMed1991

Cutis laxa, growth retardation and hip dislocation in a Sudanese child.

This case report describes the rare variant of autosomal recessive cutis laxa with bone dystrophy in a Sudanese child. The clinical features include cutis laxa, growth and development retardation, facial dysmorphism, hyperextensible joints, dislocation of the hips and a large umbilical hernia.

Child, Preschool↗