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Radiology imaging, along with clinical orthopedic assessments, plays an important role in the diagnosis and treatment of Congenital Dislocated Hips. The validity of the radiologic examinations relies heavily on the examiner or technologist. This article explains some of these examinations and describes the benefits, disadvantages, and important facts to be aware of while performing them.
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We performed a combined one-stage approach for the treatment of eighteen spastic subluxated or dislocated hips in eleven children who had cerebral palsy. All patients were between five and thirteen years old and had spastic subluxation or dislocation of the hip and severe acetabular dysplasia. The operation consisted of release of the adductors, psoas, and proximal hamstrings; a femoral-shortening varusderotation osteotomy; and a pericapsular pelvic osteotomy. The pelvic osteotomy was designed to increase superolateral coverage of the femoral head in the elongated acetabulum, which had erosion of the superior and lateral aspects. At the latest follow-up (mean duration, six years and ten months), seventeen of the eighteen hips remained anatomically reduced.
Results of a combination of soft tissue procedures performed for the first time in treating paralytic dislocation of the hip in cerebral palsy are presented. All hip flexors and adductors release, along with possible transposition or elongation of knee flexors on the side of the dislocation (if knee contracture exceeded 20) were peformed. 75 hips in 57 patients were operated on. 54 patients were analyzed. The average age of the patients was 6.6 years, the average follow-up was 7 years. Excellent result was achieved in 33patients (61%), good in 10 (18,6%), fair in 4 (7,4%) poor in 7 patients (13%). Poor results were registered in patients over 10 years of age and in patients with athetosis. Results were assessed according to clinical finding, radiological finding (migrational percentage) and the ability of patients to walk. When based on radiological findings only, excellent results were achieved in 63 hips (84%). This combination of soft-tissue procedures which includes all muscles that take part in the dislocation proved to be very successful in achieving reposition. It can be recommended to patients suffering from the spastic form of cerebral palsy up to 10 years of age.
The process of creation of avascular necrosis will be explained on account of compression of the lateral retinacular arteries in Lorenz-position, during the treatment of congenital hip dislocation and variable development of medial and lateral arteries supplying the proximal epiphysis of femur. Also will be discussed the connection between the classical Legg-Calvé-Perthes' disease and the so-called hip-dislocation-Perthes' disease.
A 35-year-old woman sustained a simple anterior hip dislocation after a fall. Initial treatment involved a closed reduction under sedation with brace immobilization. Nine months after the initial dislocation, she began having recurrent anterior hip instability (four events) requiring closed reduction under anesthesia. Secondary to the recurrent dislocations, she had a derotational subtrochanteric femoral osteotomy at an outside hospital for the anterior instability. After this procedure she sustained five additional anterior dislocations requiring closed reduction under anesthesia. After nine anterior dislocations, she had periacetabular osteotomy retroverting her acetabulum with repair of the anterior hip capsule which has successfully solved the recurrent instability. To the author's knowledge this is the first reported case of recurrent anterior hip instability treated successfully with a periacetabular osteotomy.
Computerised tomography, carried out in 5 non-treated cases of congenital dislocation of the hip, shows that the femoral head can move in a large anteroposterior cavity. When the hip is extended the common position of dislocation is lateral superior and slightly anterior to the acetabulum. When the hip is flexed (at a right angle), the femoral head is located posterior and slightly superior to the acetabulum. Dislocation reduction has always been possible. When the hip is flexed a large "click" takes place; whereas if the hip is extended, the "click" is less noticeable, or even absent.
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This case report describes two patients who sustained ipsilateral fractures of the femoral head and femoral neck without dislocation of the hip. The fractures in the two patients resulted from vehicle accidents. The femoral head was fractured in the sagittal plane, and the femoral neck was fractured at the subcapital portion. However, the hip was not dislocated in either patient. Both patients were treated using cementless total hip arthroplasty. These unusual hip injuries have not been reported previously and are not categorized according to any known classification system of hip injuries.
Twenty-six cases of traumatic hip dislocation in children are presented. Although closed reduction was achieved in most instances, open procedures had to be employed in two cases of soft tissue interposition and in a patient with ipsilateral fracture of the femoral shaft. In 16 patients, with a follow-up averaging 14 years, the incidence of complications (avascular necrosis, coxa magna and arthrosis) was significant. Factors predisposing to abnormal results were delayed reduction and severe trauma. Neither the method of immobilization nor the interval without weight-bearing over 4 weeks were of influence. Principles of treatment are suggested.
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We reviewed 52 children, born between 1974 and 1985 with spina bifida affecting L3 and L4, who had dislocated hips. Their motor function was stable and they were able to walk at the time of dislocation. They were interviewed and examined physically and radiologically. Physical function was measured by the Rand Health Insurance Study questionnaire (HIS), the Childhood Health Assessment questionnaire (CHAQ), and by determining the functional level of ambulation according to Hoffer et al (1973). In a subgroup of 12 patients with L4 level of involvement from both treatment groups we measured the metabolic energy consumption while walking. Thirty patient (49 hips) had been treated by operative relocation and 22 conservatively. Ten of the hips treated by operation subluxated or redislocated. The function in the two groups (conservative nu operated) was similar (HIS score 7.8 v 8.0, p = 0.45; CHAQ 14 v 13, p = 0.2; level of mobility 0.61 v 0.63, p = 0.5). Patients in whom operation had failed had worse function than did those with successful surgery (HIS score 8.8 v 6.1, p = 0.025) and those with successful surgery had better function than patients treated conservatively (HIS score 8.8 v 8.0, p = 0.15). Function in patients with failed operations, however, was worse than in those who did not have surgical treatment (HIS score 6.6 v 7.8, p = 0.07). In the 12 so examined the operated group had a 30% more energy-efficient gait (0.271 v 0.361 ml O2 kg/m, p = 0.05). Patients with failed operations had worse function than those who were not operated on. The benefit of surgical relocation of the dislocated hips was marginal.
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