[Congenital hip dislocation: at what age to screen with ultrasound?].
The Authors report their experience in ultrasound screening for congenital hip dislocation. Goal of this study is to recognize the best age for the screening.
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The Authors report their experience in ultrasound screening for congenital hip dislocation. Goal of this study is to recognize the best age for the screening.
The stress distribution in the subluxated hip joint is analyzed by means of a two-dimensional computer model. Luxation becomes manifest if the action line does not intersect with the contour of the socket. Pathological stress with overloading of the bone and cartilage tissue appear if the articular resultant force is shifted towards the acetabular edge. The important parameter is the CE angle. The coxa valga per se has no pathological meaning as long as the femoral head is covered sufficiently by the acetabular roof.
One hundred and forty-five cases of traumatic hip dislocation in children, complicated with avascular necrosis, were reviewed. Necrosis involved the capital epiphysis and the growth plate, and the resulting changes followed different patterns. These changes in younger children were mostly dependent on the disturbance of the growth plate, and resembled Calvé-Perthes' disease in most of its features. In older children necrosis of the femoral head occurred, as in adults. Analysis of long-term results suggest that the frequency of deformities is extremely high, and a significant incidence of degenerative joint disease can be anticipated.
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PURPOSE OF THE STUDY: This cohort illustrates growth of the center of ossification of the femoral head during and after orthopedic reduction of congenital hip dislocation. MATERIAL AND METHODS: Thirty files of pediatric patients with congenital hip dysplasia were studied retrospectively. Mean age of the children was 24.5 Months. All had unilateral dysplasia, allowing a comparison of femoral head growth by calculating the centers of ossification on the AP views. RESULTS: Mean ratio between the radiological surface of the center of ossification of the femoral head on the dysplastic side and the normal side was about 1: 2. This ratio progressed rapidly during the first Months after reduction and became 1: 1 at a mean 43 Months after reduction. Beyond this time, growth of the femoral heads followed a similar pattern. DISCUSSION: Growth of the center of ossification of the femoral head is related to biomechanical stress forces. Reduction is the only event in the natural history of the disease, but renewed growth of the femoral head cannot provoke in itself normal acetabular growth. Complementary pelvic osteotomy was required for 13 hips. CONCLUSION: Accelerated growth of the femoral head ossification center continues to be a good indicator of femoral head vitality. Early and rapid growth observed after reduction, without osteochondritis, can lead to a normal femoral head at the end of growth.
The case of a 42-year-old woman with coxarthroses secondary to old congenital dislocation of the hip illustrates that the value of computerized tomography scan in the preoperative evaluation of replacement of the dislocated hip is mainly in the tridimensional measurements of the acetabular and femoral bone stock.
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There are no reports in the literature of femoral artery thrombi occurring as a complication of open reduction of congenital hip displacement. In an 11-month-old female infant, a femoral artery thrombus most likely formed as a result of compression of the femoral artery with a muscle retractor hook used in performing Ludloff's procedure. Femoral artery thrombi should be considered as a possible complication of reduction of congenital hip dislocation with Ludloff's procedure.
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