[Ultrasonic image of congenital hip dislocation in newborn infant].
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Femur Head↗
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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↗
[Continuous traction in the treatment of congenital hip dislocation].
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Casts, Surgical↗
[Tenotomy of the psoas muscle in slow reduction of congenital hip dislocations].
PURPOSE OF THE STUDY: The aim of this study was to relate the efficacy of cutting the psoas tendon in case of high congenital hip dislocation treated by slow reduction according to Somerville-Petit. MATERIAL: Twenty psoas tenotomies were realised between 1982 and 1992. The average age was 11 months 15 days old, they were 15 girls and 5 boys. Among them, only 9 patients had never been treated. METHOD: By a short surgical approach close to the lateral lip of Scarpa's triangle, we cut the psoas tendon at the musculotendinous junction doing this suppresses the obstacle that interferes with the femoral head coming down. RESULTS: Results have been evaluated on clinically and especially radiologically. All hips remain stable except one case. A graduated subluxation of the hip occured after removal of the plaster. 18 hips have been revised between the third and fifth year. Clinical results were excellent, on radiological controls 5 hips were considered flawless, 11 satisfying, and 2 were imperfect. Only 2 children have been seen ten years later with excellent clinical and radiological results. DISCUSSION: The hypertrophic psoas tendon interposes between the femoral head and the acetabulum creasing the capsule and the limbus. Cutting tendon of the psoas will decrease the numerous unexplained failures that occured during slow reduction according to Sommerville-Petit method. The use of these surgical techniques may make more outstanding the tenotomies time. CONCLUSION: Tenotomy of the psoas tendon realized by a short surgical approach without any articular effraction, allowed us to obtain complete reduction of the hips dislocation in these 20 patients.
Casts, Surgical↗
[Long-term investigation of closed reduction of congenital hip dislocation in children with modified frog-leg cast].
From 1978 to 1983, closed reduction and fixation with frog-leg cast were used to treat congenital hip dislocation in children in our hospital. Sixty-two patients with such hip dislocation were treated by these methods. Among them 38 patients under 3 years of age were followed up for 12 to 16 years (mean 13 years). Encouraging results were obtained and the reduction rate was 97.9%. This treatment revealed that after closed reduction the fixation and the slight movement of the femoral head in the cast under the fixation are a self-remould action that may promote the growth of the acetabulum and the femoral head resulting in normal development of the hip.
Casts, Surgical↗
Overhead traction in the treatment of congenital dislocation of the hip.
Long-term results of traction treatment for congenital hip dislocation (CDH) performed between 1984 and 1990 are presented. The new traction scheme consists of 4 distinctive phases. It is based on gradually changed direction of traction--first, from the longitudinal direction to flexion and abduction against the hypomochilion. The traction is applied by means of non irritable adhesive tape using 1/4-1/5 of the child's body weight. The period of active traction is followed by retention period in Hanausek's biomechanical device. The success rate of the scheme, in terms of reduction, was 90 per cent. In 31 per cent the Salter innominate osteotomy was performed because of residual deformity. In 10 per cent of the cases open reduction was necessary.
Combined Modality Therapy↗
The c/b ratio in the radiological monitoring of the hip joint in congenital dislocation of the hip.
We report a method of monitoring hip joint development for congenital dislocation of the hip in children. The c/b ratio was measured on serial radiographs of 41 hips in 38 patients. The measurement was compared to c/b ratio obtained from normal hips. It was used to detect concentric reduction or its loss by migration of the femoral head during growth. The age at diagnosis ranged from 8 months to 10 years 6 months. The normal c/b ratio was found to change little with age. Deviation of the c/b ratio from normal in congenital dislocation of the hip resulted in a poor outcome and identified cases requiring further surgical intervention. This measurement of c/b ratio is simple and accurate, using easily determined points. The graphic display promotes critical analysis of situation and allows selection of cases at risk for treatment.
Child↗
[Proximal femoral epiphysis growth after closed reduction for congenital hip dislocation].
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.
Biomechanical Phenomena↗
Closure of the epiphysis of the femoral head and of the triradiate cartilage of the acetabulum following surgery for congenital hip dislocation.
Early closure of the epiphysis of the femoral head and of the triradiate cartilage of the acetabulum is reported in two young children following uneventful surgery for correction of deformities caused by congenital hip dislocation. Such epiphyseal arrests cause severe deformities, which frequently cannot be totally corrected. The reasons for epiphyseal arrest of the triradiate cartilage of the acetabulum following a Salter pelvic osteotomy and epiphyseal arrest of the femoral head following a subtrochanteric osteotomy are not known.
Acetabulum↗
Genetic variability in the group of patients with congenital hip dislocation.
Our study of genetic homozygosity degree includes an analysis of the presence, distribution and individual combination of 20 selected genetically controlled morpho-physiological traits in the group of patients (N = 93) with congenital hip dislocation (CDH) and in control sample consisting of school children from Belgrade (N = 200). Assuming that CDH is genetically controlled disease, we made a hypothesis that an increased homozygosity level, as well as the changed variability among the patients, could be population-genetic parameter for the prediction of the illness. Taking into consideration our experience, as well as the experience of numerous scientists who studied the nature of the inheritance of mono- and oligo-genically controlled qualitative traits, we applied a methodology to estimate the proportion of such homozygously recessive characters (HRC-TEST). This population-genetic study did not only show statistically significant difference of the middle values of genetic homozygosity (CDH-7.1+/-0.2; control - 5.2+/-0.1), but of the differences in the type of distribution too, as well as the differences in the presence of certain individual combinations of such traits. The described methodology can be used in further analyses, with hope that it can be applied as an early prognosis for decreased resistance to different diseases. The frequencies of ABO blood types in the sample of CDH patients were similar to the average value of Serbian population, while the percentage of blood group A is slightly increased. Comparing frequencies of Rh blood groups, there is no difference between tested samples.
ABO Blood-Group System↗
[The aetiology of avascular necrosis following a treatment of congenital hip dislocation and its relationship to a classical Legg-Calvé-Perthes' disease].
The process of creation of avascular necrosis will be explained on account of compression of the lateral retinacular arteries in Lorenz-position, during the treatment of congenital hip dislocation and variable development of medial and lateral arteries supplying the proximal epiphysis of femur. Also will be discussed the connection between the classical Legg-Calvé-Perthes' disease and the so-called hip-dislocation-Perthes' disease.
Femur Head↗
A comparative study of bilateral versus unilateral congenital dislocation of the hip.
The presentations, treatment requirements, results, and complications of 50 patients with bilateral congenital hip dislocation were evaluated and compared with a similar group of unilateral dislocations. Diagnosis was significantly delayed in the bilateral dislocations. The only consistent sign on initial clinical examination of the bilateral group was the symmetrical restriction of hip abduction. Treatment requirements were similar for the unilateral and bilateral dislocations, and in fact, the unilateral dislocations were more likely to undergo reconstructive procedure after successful closed reduction. Overall results, when based on age at diagnosis, were similar for the two groups. In both groups, females required less treatment and were more likely to have a good result. The complication of avascular necrosis was seen more frequently in the unilateral dislocation, while the bilateral dislocation had a higher incidence of inadequate reconstructive operations.
Child↗
Congenital dislocation of the hip.
From January 1970 to December 1976, seventeen patients with twenty-two congenital hip dislocations were treated by open reduction through a medial approach. The average follow-up was 42.2 months. The patients were evaluated for acetabular development, aseptic necrosis, and intraoperative findings. The incidence of aseptic necrosis was 10 per cent. The acetabular index improved rapidly during the first year after reduction. After the first year the rate of development was decreased, but the acetabular index continued to improve throughout the period of study. The medial approach provides a safe, effective way to reduce a dislocated hip in infancy. This procedure is advocated when closed reduction cannot be obtained by gentle manipulation or maintained by positioning once reduction is done.
Acetabulum↗
[Total hip replacement for congenital dislocation of the hip in elderly patients].
From 1986 to 1989, total hip replacement was performed on ten patients (twelve hips) with congenital dislocation of the hip. The average age of the patients was fifty-three years (ranging from forty-eight to sixty years), and the mean follow-up period was twenty-eight months (ranging from six to forty-eight months). Of the ten patients, eight had unilateral replacement and two had bilateral replacement, for a total of twelve arthroplasties. Eight arthroplasties were performed on the right and four on the left. Most patients left the hospital two to three weeks after operation. All the patients obtained satisfactory results. Only one patient developed late infection two years postoperatively. This patient occasionally used a cane for walking. The other patients had no hip pain, the motion of the hips was approximate to a normal person. No patient required a shoe-lift for limb-length discrepancy.
Age Factors↗
Assessment of congenital hip dislocation with real-time ultrasound: a pictorial essay.
Real-time ultrasound (US) is the imaging method of choice for diagnosis and follow-up of congenital dislocation of the infant hip (CDH). Clinical aspects and the role of imaging are reviewed. Technique and anatomy, both normal and abnormal, are illustrated, as well as, the use of sonography during treatment with Pavlik harness and spica cast. Correlation of ultrasound findings with clinical examination, other available imaging studies and long-term patient follow-up shows 100% sensitivity and 100% specificity for real-time US diagnosis of CDH.
Hip Dislocation, Congenital↗
[STUDY OF RADIATION INJURY CAUSED BY REPEATED X-RAY EXAMINATIONS IN CHILDREN WITH CONGENITAL HIP DISLOCATION].
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Abortion, Induced↗
[Indication and efficiency of different operations in congenital hip dislocation (author's transl)].
The efficiency of different operations for congenital hip dysplasia is discussed here. Up to the age of 6 years Salters osteotomy and the acetabuloplasty of Lance in a modified form will achieve similar results. In cases with an acetabular index higher than 35 degrees acetabuloplasty is more effective. After our own experience acetabuloplasty can be used in all age groups where there is no congruency between acetabulum and femoral head. In congruent cases Salters osteotomy can be used up to 14 years combined with varus-osteotomy if dysplasia is of moderate degree. Chiaris osteotomy should be reserved for extreme cases, where other methods will not succeed.
Acetabulum↗
[Clinical and ultrasonic diagnosis of congenital hip dislocation (dynamics of changes in early therapy)].
The authors present part of their prospective epidemiological study of congenital dysplasia of hip joints within which newborns were examined by ultrasonogram prior to the beginning of the therapy. Apart from the standard examination in the frontal plane after Graf they examined on principle also the ultrasonographic stability by the dynamic test after Schuler as well as by the application of the probe anteriorly with the simultaneous provocation according to Palmén. The authors have processed pathological ultrasonographic findings in 53 newborns (64 hip joints). The technique of the examination by ultrasound from the anterior approach is explained in detail. The comparison of both dynamic tests has shown that the examination from the anterior approach is considerably more sensitive than Schuler's dynamic test and also fully correlates with the clinical finding. It is a fact that the shift of the head in the flexion dorsally represents the most important component of the movement in unstable hip joint during provocation, it is far more noticeable than the lateralization of the head or the shift in the cranial direction. After achieving ultrasonographic stability the classical Graf method is sufficient for the registration of residual changes on the acetabular rim. The follow-up of patients until their complete healing has shown a surprisingly rapid remodellation of hip joints. The whole complex of clinically unstable hip joints has been divided into subgroups according to Graf classification. In type IIc or IId on the basis of ultrasonographic examination from the anterior approach the stable joints from the ultrasonographic viewpoint have been distinguished from unstable ones. The follow-up carried out in short intervals has shown that of longest duration is the remodellation of total dislocation and, on the contrary, of shortest duration is the healing of joints in the IIc or IId type. An absolute majority of affected hip joints have become normal until 3rd month of the age. The complex does not include two patients with teratological dislocation, the incidence of which has been determined in our study by the ratio of 2 cases in 35,550 of timely examined newborns. The role of the factor of spontaneous stabilization cannot be in this part of the study completely discounted. However, herewith we present part of an accomplished epidemiological study where the number of timely diagnosed patients including late diagnoses corresponds to the number of dislocations and subluxations determined within the conventional late diagnosis.
Female↗