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[Radiologic detection of congenital hip dislocation at the 4th month].

For the systematic detection of the congenital dislocation of the hip the roentgen examination must be performed at the beginning of the fourth month. At birth, only are X rayed the dislocations clinically detected in order to have a picture for the follow-up and to check the beneficial effect of the treatment by an abduction device. At the fourth month, for radiological detection, an ordinary frontal film of the pelvis is performed with a strict technique. The criteria of a well performed radiograph are given. For the diagnosis of dislocation the roentgen signs are quite precise. Among them, the high-value of the acetabular angles is not longer considered as a good criterion for detection at this age. It has been shown that radiological mass screening is beneficial from the socio-economic and radiation risk point of view. Nevertheless such a mass screening, in our opinion, is not advisable. Radiological screening must be restricted to infants at risk (infant born after breech presentation, infant with pes talus, genu recurvatum, torticollis, infant with other cases in the family, first born in a family, mainly if of important birthweight).

Hip Dislocation, Congenital↗

Obturator hip dislocation with ipsilateral fractures of the femoral head and femoral neck. A case report.

A 28-year-old female pedestrians, struck by an automobile, sustained an obturator hip dislocation with concomitant ipsilateral fractures of both the femoral head and femoral neck. This unusual hip injury seems not to have been previously reported. The femoral neck fracture was widely separated from the shaft, and unfortunately, a 6-mm deep indentation fracture involved the anterosuperior portion of the articulating surface of the femoral head. This complex injury was treated with a press-fit bipolar prosthesis.

Adult↗

Congenital hip dislocation or dysplasia with subluxation: a radiologic study.

We studied the behavior of hips in congenital hip dislocation. Two types were identified: those that developed normally after closed reduction and those that required an osteotomy. Children with hips that required an osteotomy were older at presentation and at follow-up had worse subluxation, with shallower acetabula. In this group, the younger the age at which reduction was achieved, the less the residual subluxation of the hip at follow-up. The age at which the late osteotomy was performed did not appear to affect the residual hip subluxation or the acetabular development. We could not find any radiologic parameter that would predict the need for an osteotomy.

Child, Preschool↗

Open reduction of the dislocated hip in juvenile idiopathic arthritis: a case report.

An 8-year-old girl with systemic-onset juvenile idiopathic arthritis (JIA) required surgical reduction for a dislocated left hip joint following failure of skin traction for 1 week. Unaided walking was achieved by 3 months postoperatively. Incongruence and irregularity of the hip joint remained but may resolve with maturation. Joint laxity caused by synovitis, flexion/adduction contracture with pain, and acetabular dysplasia by growth disturbance apparently caused hip dislocation.

Journal Article↗

Closed treatment of hip dislocation in Down syndrome.

Two young children (three hips) with Down syndrome and dislocation of the hip were successfully treated by nonoperative methods by using the principle of prolonged immobilization or bracing. A 5-year, 6-month-old patient with bilateral habitual dislocation used an ambulatory abduction orthosis full-time for 6 months and then part-time for 4 months. Complete dislocation of the right hip in a 4-year, 6-month-old patient was managed by closed reduction, spica cast immobilization for 4 months, and then an ambulatory abduction orthosis for 8 months. Both patients developed stable, well-contained hips. Nonoperative management of hip dislocation in Down syndrome can be successful and avoids the complications associated with operations previously recommended for these patients.

Braces↗

Femoral shaft fracture with ipsilateral hip dislocation in a child.

A child victim of low speed violence was found to have a fractured femur and dislocation of the ipsilateral hip. This combination of injuries in a child is very rare. The dislocation was not initially recognized because of absence of suggestive history, symptoms, and signs. After recognition, open reduction of the hip dislocation was achieved through a posterior approach. One month later an osteotomy at the femur fracture allowed the leg to fall to neutral while maintaining the femoral head in the most desirable position.

Adolescent↗

[Clinical, radiological and personal condition of patients over 18 year of age with congenital hip dislocation treated conservatively].

The paper presents the clinical, radiological and personal condition of 121 patients (162 hip joints) age 18 to 32 years (mean age 24 years) treated during childhood because of congenital hip dislocation. In 34% of the cases slight and moderate pain was reported, but no other symptoms were found during follow-up. Radiological condition was assessed as very good in 34% of the cases, good in 48%, satisfactory in 6% and unsatisfactory in 5%. Structural changes in spongy bone, which may be early signs of degenerative disease were found in 3 hips. These changes were visible on X-ray films as a sign of increased density in the upper rim of the acetabulum. The assessed patients lead a normal life, work, often doing a job that is inappropriate for people who should take special care of their hip joints.

Acetabulum↗

Unilateral congenital hip dislocation with contralateral avascular necrosis.

Seventy-six children with previoulsy undiagnosed unilateral congenital dislocation of the hip were examined after 2 years of age. Nine had radiologic signs of dislocation on one side and avascular necrosis of the contralateral femoral head. The incidence of necrosis on the contralateral side in older children with unilateral dislocation is much higher than among the normal population. The cause of these occurrences of aseptic necrosis is not known but could be associated with abnormal stress on an undislocated femoral head from dysfunction of a contralateral unstable dislocated femoral head.

Child↗

[Development and formation of the hip joint in children with surgically treated congenital hip dislocation].

The aim of this paper was to evaluate the development of different elements of the hip joint after surgical treatment, depending on age, anatomic conditions and degree of dysplasia at the time treatment was implemented. 100 hip joints were evaluated in 76 children treated because of congenital hip dislocation with the Dega or Chiari method in the years 1988-1993, according indication proposed during the XXVI Conference of the Polish Orthopedic Society. Age of patients at the time of surgery ranged from 2.5 to 7.5 years. There were 62 girls and 14 boys. The Dega method was implemented in 85 joints and the Salter method in 12 joints. Follow-up period ranged from 5 to 10 years. The best results were obtained in children who underwent surgery before 4 years of age.

Age Factors↗