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PubMedDate not supplied

"Perthes-like" changes in a free riding untreated congenital dislocated hip.

The development of avascular necrosis of the femoral head (AVN) after the treatment of congenital dislocation of the hip (CDH) is a well-known complication, but the coexistence in an old child of untreated CDH and ischemic changes of the femoral head has not been reported. Many authors and several years of clinical observation have shown that Perthes-like changes do not occur unless the two sides of the joint are in contact. The purpose of this paper was to report a case of Perthes-like disease that occurred in an untreated CDH, and to discuss the possible pathogenesis. The patient is an 8-year-old African American girl, who presented with a leg length discrepancy, and very mild complaints at the left hip. Physical examination revealed left hip stiffness with a positive Galeazzi sign. Pelvic radiographs showed a complete high riding dislocation of the left hip, with a small and dense femoral head. MRI showed a decreased signal of the entire femoral head. Hematologic and metabolic work-up was normal. Although the vascular theory seems to be well accepted in the pathogenesis of Perthes disease, it does not seem that the contact between the femoral head and the acetabulum is necessary to produce ischemic changes of the femoral epiphysis.

Child↗
PubMed1990

[Treatment of the dislocated hip from walking age to 5 years].

Review of 93 previously not-treated congenital dislocations of the hip, followed at the Institute Calot between 1965 and 1985. Three dislocations were treated by immediate surgical reduction and for the remaining 90 cases, the basic treatment was orthopedic reduction followed by innominate osteotomy. Femoral derotation osteotomy was also performed in 13 cases. Out of them 6 with various effect. Surgical reposition was necessary in 9 cases. The main technical aspects and problems are described. The complications were: abnormal development of the superior femur: 4 cases. Recurrent luxation and subluxation: 5 cases. Early fusion of the triradiate cartilage: 13 cases. Mostly transitory stiffness: 17 cases. Superficial sepsis: 7 cases. Greenstick fractures: 5 cases. Forty five hips were reviewed at the end of the growth period. The sphericity of the femoral head was evaluated according to the criteria of Mose and the coverage of the head according to the criteria of Lequesne. The results were presented according to the classification of Séverin, modified by Robert and Seringe with additional criteria of Mose for evaluation of the morphology of the head. Out of 45 cases there were 36 normal hips (80%), with 12 perfect hips.

Child, Preschool↗
PubMed1995

[Treatment of hip dislocations and subluxations by Petit's splints].

PURPOSE OF THE STUDY: The management of DDH in infants less than one year old is not yet definite. Many ambulant therapeutic methods are described and Pavlik's harness is widely employed. The use of Petit's splints is less well known and we report our experience with 169 cases. MATERIAL AND METHOD: Between 1973 and 1991, Petit's splints were used in 112 cases, following abduction cushions in 55 cases and after Pavlik's harness in 2 cases. 103 hips were dislocated but reducible. This permitted progressive abduction of the hips in order to obtain the reduction of the dislocation and to ensure stabilization by retraction of the slack articular capsule. RESULTS: Only 8 dislocations (4,7 per cent) couldn't be reduced by this procedure and necessitated another treatment. Hips were normal after 5 years of follow up in 118 cases and there were 43 residual dysplasias. 6 post reductional avascular necrosis (3,7 per cent) were recorded as a complication of this method among which only one was a serlous from. DISCUSSION: This ambulatory method for treatment of congenital hip dislocation seems to be forsaken by many authors. Nevertheless its effectiveness has been demonstrated with a complication rate lower than with Pavlik's harness procedure.

Female↗
PubMed1976

[Evaluation of the effectiveness of orthopedic manipulation of inveterate traumatic hip dislocation].

The authors present an analysis of the results of operative treatment for inveterate femoral dislocations in 13 patients, in 6 of them open reduction of the dislocation was performed, in 6--arthrodesis of the coxa, in 1--subtrochanteric osteotomy. The late results within the terms from 3 to 15 years were followed up in 9 operated patients, 5 of them were previously subjected to operative reduction of the dislocation and 4--to arthrodesis. It is the authors' opinion that, taking into account the late results following operative reduction of inveterate femoral dislocation, the operation of arthrodesis of the coxa is felt to be more rational in such cases.

Adult↗
PubMedDate not supplied

Anterior hip dislocation in children with cerebral palsy.

This is a report of 27 hips with anterior dislocation in 17 children with cerebral palsy. Type 1 consists of patients with extension-external rotation and adduction contracture of the hip and extension contracture of the knee; type 2 consists of patients with extension-external rotation and abduction contracture of the hip and flexion contracture of the knee; and type 3 consists of patients without contractures. All children with types 1 and 2 were unable to sit and were forced into an almost full-time lying position. No child with type 3 pattern had sitting troubles. Hip pain was present in 50% of patients. All children with type 1 pattern and half of children with types 2 and 3 developed a thoracolumbar kyphosis. Standard radiographic hip measurements were inconsistent, and only three-dimensional computed tomography scans were useful in fully assessing the deformity. Indications for hip surgery were inability to sit or hip pain or both. Reconstruction was performed by anterior superior acetabular reconstruction and varus-shortening femoral osteotomy or proximal femur resection as a salvage procedure. Although three of the 13 children required two procedures, 11 of 13 children who underwent 16 hip procedures had stable and painless hips at the time of follow-up.

Adolescent↗
PubMedDate not supplied

[Osteomyelitis of the ischium with ipsilateral hip dislocation in an infant].

Acute hematogenous osteomyelitis of the os ischii is a rare disease. Involvement of the acetabulum in a 4-month old girl with concomitant developmental dysplasia of the ipsilateral hip caused a dislocation of the hip joint due to synovitis. Arthroscopic joint lavage, antibiotic treatment and reduction of the hip in a pavlik-harness led to a satisfactory result.

Anti-Bacterial Agents↗
PubMed1988

[Treatment of chronic hip dislocation in adults by recentered total prosthesis. Apropos of 43 cases].

Forty-three total hip prostheses were inserted in 33 adults suffering from a chronic high dislocation of the hip. Ten patients had a bilateral arthroplasty. The authors decided to keep in this series only hips presenting with a very considerable upward displacement of the femoral head of type IV in Crowe, Maini and Ranawat's classification. All the hips were treated in the same way with pre-operative planning using template tracings to anticipate problems of length and choice of implant. The acetabular cup was placed in the old acetabulum with downward displacement of the femur. The results were studied in 39 prostheses with a mean follow-up of five-and-a-half years (two years to nine-and-a-half years). The mean age of the patients was 48 and-a-half years (28 to 76 years). A satisfactory result was obtained in 79.5 per cent of cases. The mean downward displacement of the femur was 4.8 cm. Complications included one death from pulmonary embolus, two phlebitides, two fractures of the femoral shaft and four dislocations. There were nos cases of sepsis or neurological complications. The authors advise the use of custom-made implants, consider the tactical problems relative to the opposite hip. It is concluded that the value of the method often lies in the transformation of the life of these young patients by a "functional miracle", but the operative indications need to be considered carefully, since the procedures are sometimes extensive, often difficult and always require technical skill.

Adult↗