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PubMed1985

[Etiology, pathogenesis and pathology of dysplastic hip dislocation].

Neonatal hip examination and early therapy of CDH proofed to be best in preventing early osteoarthritis of the hip. Nevertheless we still happen to be confronted with congenital dislocated hips and hip dysplasias diagnosed after walking age. The pathologic changes of the dislocated hip joint are described.

Child Development↗
PubMedDate not supplied

[Developmental tendency of the femur head following femoral head necrosis due to conservative treatment of a dislocated hip (2nd report)].

The development of the proximal femur was studied in a follow up of 64 patients--on average 24.4 years of age--with congenital hip dislocation and 101 subsequent aseptic necroses of the femoral head. For measurement of the angle of antetorsion and the femoral neck-shaft angle, biplanar radiographs were taken. A coxa valga with a true femoral neck-shaft of 137 to 164 degrees was present in one third of the cases with partial necrosis and in the group without necrosis. An increasing degree of necrosis led to coxa vara. Damage of the capital epiphysis caused development of coxa vara (average of 115.77 degrees), overgrowth of the greater trochanter and increase of femoral antetorsion (average of 30.23 degrees). Pre-existing damage of the capital epiphysis following non-operative treatment of congenital hip disease or Perthes disease cannot be recommended for intertrochanteric varisation osteotomy.

Adolescent↗
PubMed1981

A previously unreported, dominantly inherited syndrome of shortness of stature, ear malformations, and hip dislocation: the coxoauricular syndrome--autosomal or X-linked male-lethal.

We reported an apparently previously undescribed syndrome, designated the coxoauricular syndrome, in a mother and her 3 daughters, all of whom shared in variable manner shortness of stature, minor vertebral and pelvic changes, dislocated hip(s), and microtia with corresponding hearing loss. The oldest daughter had coincidental Ullrich-Turner syndrome with 46, Xdel(X)(q 13) chromosome constitution. Inheritance of the trait in this family is dominant, either autosomal or X-linked, with hemizygote lethality.

Adult↗
PubMedDate not supplied

[Results of treatment of old congenital hip dislocations after the start of walking].

Between 1980 und 1986 32 patients with 42 longstanding congenitally dislocated hips were treated by operation. Age at surgery ranged from 13 months to 18 years (mean 4.5 years) with a follow up of 6.7 years. Surgery was done by open reduction mostly combined with innominate and femoral shortening osteotomy. Not in all cases this was done as a one stage procedure. Results were excellent in 20 hips, good in 11, and poor in 11 hips. Quality of results decreased with age at surgery. The best results could be achieved with the one stage combined operations (open reduction, capsuloraphy, femoral shortening osteotomy, iliac osteotomy). The rate of avascular necrosis of the femoral head was 7.14%. The poor results mostly depended on the operating technique and the indication of surgery in cases with no or with extremly flat acetabulum.

Adolescent↗
PubMedDate not supplied

[Results of the follow-up of Ludloff open hip repositions and closed repositions in congenital hip dislocations].

Three combinations of therapy of CDH (closed and open reduction, with and without foregoing so called "functional" conservative treatment, and with and without retention in the frog position) have been evaluated among 82 children with 100 dislocated hips. They had been operated on 71 times by Ludloffs open reduction and 29 times by gentle closed reduction in anaesthesia. If following a test-x-ray in 130 degrees flexion of the hips and 50 degrees of abduction no spontaneous reduction occurs, an attempt at careful closed reduction under anaesthesia seems to be justified. If it is not successful with lack of a deep position of the head, an immediate open reduction after Ludloff with retention in hip flexion of about 130 degrees and slight abduction was in our hands less frequently followed by an avascular necrosis of the femoral head than following conservative treatment. The latter and the inhuman frog position are according to our statistics probably more responsible for the avascular necroses than the open reduction as such. Every treatment of CDH has to be evaluated in regard to the frequency of irreversible avascular necrosis of the femoral head.

Casts, Surgical↗
PubMed1981

Incidence of avascular necrosis of the femoral head in congenital hip dislocation related to the degree of abduction during preliminary traction.

Two-hundred and twenty-two congenitally dislocated hips of 173 patients had been abducted in one of two fashions, prior to closed reduction under general anaesthesia. In both forms of treatment, the hips were in 90 degrees of flexion while they were abducted. Group 1 included those who were abducted up to 90 degrees and Group 2 those who were abducted to not more than 60 degrees. The incidence of total avascular necrosis was 90% when the limbs were abducted to no more than 60 degrees and 17% in those abducted up to 90 degrees. The incidence of partial avascular necrosis was not affected by the degree of abduction of the hips. The incidence of avascular necrosis in Group 2 patients is comparable to that in recent reports of patients who received their traction with the hips in extension; this suggests that the flexed position is not harmful, and it is certainly effective and convenient.

Child, Preschool↗
PubMed1982

Congenital hip dislocation after walking age.

Between 1940 and 1970, 107 patients more than 1 year of age with 134 congenitally dislocated hips were treated at the Alfred I. duPont Institute. It was found that after initial reduction 66% of hips reduced closed and approximately 30% of hips reduced open required further surgery. Good acetabular development was seen in 19% of hips reduced between 2 and 3 years, but only in 7% reduced after 3 years of age. The best results in the correction of residual dysplasia or subluxation were seen if correction was done before 6 years of age. Avascular necrosis was highest after simple open reduction and was responsible for most of the fair and poor results, with late development of poor femoral head coverage after an initial concentric reduction with good coverage.

Age Factors↗
PubMed1987

Surgery for hip dislocation in cerebral palsy.

In 10 children seriously disabled by cerebral palsy, 12 dislocated hips were surgically reduced. The main indications for surgery were impaired perineal care, decreasing sitting balance, and pain. Furthermore, the operations were considered in order to anticipate major problems in the future, such as the wind-swept hip phenomenon and pain in the hip. At follow-up, it appeared that all the children had profited from the surgical procedures.

Cerebral Palsy↗
PubMed2002

Painful spastic hip dislocation: proximal femoral resection.

The dislocated hip in a non-ambulatory child with spastic paresis tends to be a painful interference to sleep, sitting upright, and perineal care. Proximal femoral resection-interposition arthroplasty is one method of treatment for this condition. We reviewed eight hips, two bilateral cases, with a mean follow-up of 30 months. Clinical improvement was observed in all except one case, with respect to pain relief and sitting tolerance. Some proximal migration was observed in three cases, despite routine post-operative skeletal traction in all cases and careful soft tissue interposition. One case showed significant heterotopic ossification which restricted prolonged sitting. This patient needed some occasional medication for pain.

Adolescent↗
PubMed1989

[Studies of hip dislocation in twins].

An arbitrary series of twins is used to demonstrate that there is no increased morbidity from congenital dislocated hip joint in twins. A physiologic delay in ossification of the cartilaginously preformed parts of articulations is caught up during the first year of life. In addition, connection with pregnancy and birth is discussed and r recommendations for diagnosis and therapy using sonography are given.

Birth Weight↗
PubMedDate not supplied

Postoperative computed tomographic evaluation of congenital hip dislocation.

The use of computed tomography (CT) in the postoperative evaluation of 19 congenitally dislocated hips is presented so that appropriate indications for reduction can be determined and radiologic criteria can be defined for judging whether reduction is satisfactory. The radiologic technique is presented. CT is an accurate and cost-effective modality that is capable of demonstrating subtle changes in femoral head position.

Female↗
PubMed1986

Safety seat use for children with hip dislocation.

Treatment of children with congenitally dislocated hips requires that an infant be placed into a plaster spica cast for a duration of 3 to 12 months. Because the use of a safety seat is difficult, if not impossible, for children fitted with a brace or spica cast, a solution for safe transportation was developed. A Century child restraint model 100 or the Century model 300 was selected as appropriate for modification. Seat padding was removed from the lower sides of the plastic shell, and the shell was cut. The seat padding was replaced and taped tightly to the outer side of the shell. An impact test of the modified safety seat at the University of Michigan Transportation Research Institute indicated that the modification of the shell did not compromise the performance of the restraint system. Seats with this modification have been loaned to children treated at the James Whitcomb Riley Hospital for Children with satisfactory results.

Casts, Surgical↗
PubMed1995

Hip dislocation caused by infantile myofibromatosis.

An unusual case of newborn unilateral dislocated hip is presented. The condition was refractory to conservative treatment. The cause was found during surgery at the age of 1 month: the adductors were replaced by myofibromatosis. The tumor was excised and at follow-up a normal hip was noted.

Female↗
PubMed1976

An evaluation of conservative and operative methods in the treatment of congenital hip dislocation.

An evaluation of different methods of closed reduction of dislocated hips during different periods of time shows that manual reduction and fixation in Lorenz position account for a high rate of avascular necrosis. Even with functional and slow reduction by Pavlik harness and overhead extension, there is still a certain percentage of femoral capital necrosis. The fetal position recommended by Fettweis and Salter seems to reduce the incidence of necrosis. Acetabuloplasty combined with detorsion-varus-ostcotomy provides the means of normalizing a hip joint with a greater degree of success than most other methods.

Acetabulum↗