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Hip dislocation in cerebral palsy: selection for treatment.

Forty-five patients with cerebral palsy hip-dislocation were reviewed and it was found that some did well without treatment. For patients with hip pain, the best results were obtained with extensive resection arthroplasty: soft-tissue surgery alone was unsuccessful. Open reduction with femoral osteotomy achieved concentric reduction in all 15 patients who had this type of surgery: however, most retained their abnormal postural reflex activity to such a degree that subsequent scoliosis, pelvic obliquity, hip extension contractures and knee flexion deformities compromised the success of the hip surgery.

Adolescent↗

Traumatic avulsion of the proximal femoral articular cartilage as a cause of hip dislocation in broiler chickens.

Review of the normal anatomy of the coxofemoral joint in broiler chickens aged seven weeks and comparison with cases of so-called "hip-dislocation" revealed that the lesion is essentially an avulsion of the articular cartilage of the femoral head, traumatically caused by the manner of catching and handling of birds. No direct relationship to dyschondroplasia (osteochondrosis) was established.

Animals↗

Congenital hip dislocation: before and after walking age.

Residual morbidity from congenital dislocation of the hip is for the most part preventable. Prevention is possible, however, only by establishing the diagnosis early and undertaking treatment which leads to stable reduction and avoids complications. To attain these goals, hip examination whould be a routine part of all newborn care. When dislocation is found in a newborn and early treatment initiated, the anatomic abnormalities are minimal, the dislocation is rasily reduced, and the treatment is simple. When diagnosis and treatment are delayed, the soft-tissue and bony abnormalities become established and therapy becomes more complicated.

Age Factors↗

Can simple radiographs be predictive of total hip dislocation?

The usefulness of angles measured on standardized radiographs to determine acetabular position and predict dislocation after primary total hip arthroplasty (THA) was reviewed retrospectively. Seventy-four patients (97 primary THAs) were reviewed. All patients underwent a standardized protocol of postoperative radiographs which included an anteroposterior view of the pelvis and a cross-table lateral radiograph of the hip. Two angles were measured to define acetabular position: the abduction angle was measured on the anteroposterior radiograph and the version angle was measured on the cross-table lateral radiograph. The values for these angles were compared in a group of known dislocating THAs (7 hips) and a control group of stable THAs (90 hips). These radiographic measurements were also assessed for their reproducibility. The values for the abduction and version angles were not significantly different between the two groups. The values for abduction and version angles for a given hip, from one examination to another, were reproducible. Neither the abduction nor the version angle was a predictor of dislocation.

Biomechanical Phenomena↗

[Comparative evaluation of clinical and ultrasonographic screening of hip dislocation in Breton and Languedoc populations].

BACKGROUND: Congenital dislocation of the hip varies greatly in incidence among different regions. This work is aimed at comparing results of clinical investigation and ultrasonography of the hip in Languedoc-Roussillon and Brittany. POPULATION AND METHODS: Two thousand eight hundred and twelve and 2,809 neonates admitted to Nîmes and Vannes hospitals respectively, were enrolled in a prospective study. Clinical examinations were made according to the protocol established by the "Groupe d' études en orthopédie pédiatrique". Ultrasound investigations were performed in every risk case. RESULTS: No dislocation occurred in the 4946 neonates without risk factors. In the 675 neonates with risk factors, 213 ultrasonographic examinations were abnormal, more frequently in the Brittany group (P < 0.001); nine dislocations were observed. A familial history of hip dysplasia (P < 0.001) and the addition of two risk factors (P < 0.001) were more frequent in Brittany. One hundred and six cases required treatment, more frequently in Brittany (P < 0.001). CONCLUSIONS: Some clinical risk factors and delayed ossification or hip dysplasia at ultrasound examination are significantly more frequent in Brittany. Clinical examination with selective ultrasonography is a reliable method, allowing early diagnosis and treatment of delayed dislocations.

Adult↗

[Pathogenesis and prevention of spastic hip dislocation].

Based on retrospective analysis of 82 hips of 41 patients with cerebral palsy, a pathogenetic model of spastic paralytic dislocation of the hip is introduced including recent observations of the normal hip development. According to this model the reduced activity of the gluteus maximus, medius, minimus and quadriceps femoris muscles, which normally cause a decrease of valgus and anteversion, results in an increased subluxating coxa valga antetorta with a consecutive dislocation. In order to prevent a dislocation, these muscle groups have to undergo increased activation. Since walking has to be to undergo increased activation. Since walking has to be considered the strongest stimulus for the dislocation-preventing hip abductors, hip extensors, outward rotators and knee extensors, the erect gait should be encouraged with statomotorically favored children early as possible. This can be supported by muscle relaxing surgery of the antagonistically effective hip flexors, hip adductors and inward rotators as well as the knee flexors. These muscle release operations will counteract, although to a limited extent, a dislocation even with a severely handicapped child who is unable to walk.

Adolescent↗

Medial-approach open reduction of hip dislocation in amyoplasia-type arthrogryposis.

In 95 children with amyoplasia-type arthrogryposis multiplex congenita, 40 hip dislocations in 26 patients were found. In 16 of these 26 patients, bilateral (nine patients) and unilateral (seven patients) dislocations were reduced by a medial-approach open reduction. The mean age at the time of surgery was 8.9 months. Acetabular development was satisfactory. Complications included one early redislocation, two hips with stiffness, and four of 25 hips with avascular necrosis (types 1 and 2). Overall 80% (five of seven unilateral, 15 of 18 bilateral hips) were rated good and 12% fair, and 8% (one of seven unilateral, one of 18 bilateral) were poor. Stiffness or asymmetry was not observed in the nine bilateral cases. This study suggests that dislocations in infants with amyoplasia may be successfully reduced by medial-approach open reduction. Bilateral reduction and concurrent correction of other lower limb contractures may be accomplished during the same surgical session.

Arthrogryposis↗

Congenital hip dislocations diagnosed after walking age: results of treatment.

The results of treatment of 64 congenital hip dislocations, diagnosed after the children were of walking age, were assessed anatomically, using two criteria--general femoral head shape and the C.E. angle of Wiberg. Results were also related to age at diagnosis and treatment methods. Radiologically 62% of the hips had normal or good results, and of these, 82% were obtained when the diagnosis was made and treatment started before the age of 36 months. In this series no correlation existed between anatomical result and treatment method.

Age Factors↗