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PubMed1993

[Results of surgical repositioning of congenital hip dislocation].

The authors submit an analysis of the results of surgical treatment of inborn dislocation of the hip joint in children from the age of one year to completed growth. Decisive for inclusion into this group was surgical reposition. The operated patients were divided into the following three groups by age at the time of operation: 1. first year up to 17 months; 2. 18 to 48 months; 3. patients older than 4 years up to 15 years. Between 1978 and 1992 96 children with inborn dislocation of the hip joint were operated (103 hip joints). Complete documentation was available for 59 hip joints of 54 patients. The follow up period varies between 1 and 14 years after operation. In the first group 24 hip joints of 21 patients were checked, the average age at the time of operation being 8 months. In 17 hip joints at the same time subtrochanteric osteotomy with abbreviation was performed. In these operated hip joints surgical reposition was preceded by distraction either using the "overhead" system or the Pavlanský's method. All hip joints in this group were operated from an anterolateral approach according to Scaglietti's principles. In the second group 19 hip joints of 16 patients were checked, the mean age at the time of operation being 28 months. A standard component of the operation was in addition to surgical reposition also pelvic osteotomy according to Salter's method, in 16 cases at the same time derotation varus osteotomy was performed. The third group comprises 16 hip joints of 15 patients operated at an average age of 9 years and 8 months. Fourteen of the hip joints had been operated previously at least once by different methods. In acetabular dysplasia different techniques were used, most frequently Chiari's osteotomy. The surgical reposition proper was preceded in four instances of high iliac dislocation by preoperative distraction by external fixation. For evaluation of the results clinical and radiological parameters were used, essentially identical with Severin's classification. X-ray evaluation was supplemented y values of the distance between the head and Köhler's protrusion. The best clinical and X-ray results were achieved in the first group; wih the number of previous operations and advancing age the perspective of excellent results declines. In the group as a whole five, i. e. 8.5%, avascular necroses were recorded. From the total number of operated patients good radiological results were achieved in 83%, 17% of the results are considered satisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1993

[Cooperation between the pediatrician and orthopedist in the diagnosis of congenital hip dislocation].

The author summarizes the principles of clinical diagnosis, referring to experience assembled in an investigation comprising more than 35,000 neonates during past years. The submitted pattern could be a practical instruction for examination of the hip joints by paediatricians--neonatologists. The author emphasizes the fact that the diagnosis of complete dislocation unless irreponible is very easy, and being a clinically very obvious defect, it should not be missed. In other countries the trend predominates to ensure examination of the hip joints of neonates by paediatricians-neonatologists for whom this examination is a matter of routine. The author outline possibilities of ultrasonographic examination, static as well as dynamic. In large towns it proved useful to establish an ultrasonographic examination room where some 4000 infants aged 2-3 weeks are examined. The hitherto used classification of ultrasonic examination is not quite reliable in view of "over-diagnosis" and thus to unnecessary therapy which can lead--as any abduction therapy--to complications such as avascular necrosis. Paediatricians-neonatologists should master the clinical problem and be aware of the responsibility for early clinical diagnosis to enable orthopaedists to specify indication for early treatment based on ultrasonographic examination.

Hip Dislocation, Congenital↗
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↗