[Ultrasonographic diagnosis of congenital hip dislocation].
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Visual analysis of dynamic ultrasonography was employed in the assessment of hip stability in the neonate/infant. The 'black hole' sign visually describes the clearly recognizable ultrasonographic image of hip dislocation/dislocatability. This sign adds objectivity to the technique of visual analysis and is to be recommended.
The authors use a radiographic approach to demonstrate the primary role of the triradiate cartilage in hip development in the normal child and in congenital dislocation of the hip. The orientation of this cartilage with respect to the dysplasia gives an indication as to the prognosis of the CDH. The acetabular angle is of lesser interest with respect to the orientation of the triradiate cartilage on the pelvic radiographic examination.
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The comparison of the results obtained by conservative or operative treatment of hip dysplasia shows that the consideration of absolute roentgenologic hip parameters is of little use. Classification principles for numerous hip parameters have been developed for this reason by Tönnis. In the Angloamerican and Scandinavian countries, on the other hand, it is predominantly the Severin classification that is employed for an evaluation of the methods of treatment. We examined in our study the differences in the evaluation of the results obtained in 117 hip joints treated by pelvic osteotomy according to Salter by application of the AKH and the Severin classification scheme. There were evident differences in all groups of these classifications. In the application of the Severin scheme the groups I, II and III contained 9.5% less, 24.8% more, and 18.8% less hip joints, respectively than in the respective groups of the Tönnis classification. In the groups IV, V and VI of the Severin classification there were altogether 3.5% less hip joints than in the respective groups of the Tönnis classification. Our study thus showed that a comparison of the operative results of hip dysplasia as presented in the Angloamerican and Scandinavian literature and those presented in the German literature is not possible. We conclude from this result that an evaluation according to a unified classification scheme would be most desirable.
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Ninety-four hips involved with total avascular necrosis in the treatment of congenital dislocation of the hips were reviewed in a search for etiological factors and effective salvage procedures. Pre-reduction traction and adductor tenotomy did not prevent avascular necrosis. Abduction of the hip in the "frog" position was the incriminating common denominator. This position may cause (1) interference of the blood supply to the femoral head by compression of the medial branch of the deep profundus artery; and (2) pressure on the intraepiphyseal grooves by the glenoid labrum. The containment of the femoral head by acetabuloplasty (preferably) below age 8, followed at a later date (over age 10) by transfer distally of the greater trochanter, with the abductor muscles, offers a satisfactory salvage procedure.
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