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PubMed1977

Blood supply of the head of the femur in traumatic hip dislocation.

Traumatic dislocation of the hip causes circulatory embarrassment in the femoral head in both adult and immature rabbits. Damage to the extraosseous epiphyseometaphyseal vessels of blood supply and drainage is a major causative factor. Disturbance of circulation is most severe in immature rabbits and worsens with continued dislocation to finally reach a maximum within a period of 24 hours. In adult rabbits, the intraosseous epithyseo-metaphyseal anastomoses across the obliterated growth plate minimize the effects of damage to the extraosseous epiphyseal nutrient system. Early reduction of the dislocated hip enhances early and complete recovery of blood supply to the femoral head. Reduction of the dislocated hip delayed to 12 hours or longer does not benefit the rate and extent of the circulatory recovery of the femoral head. Histologically demonstrable aseptic necrosis of the femoral head occurs in the majority of rabbits, regardless of skeletal maturity or reduction. It is more common and extensive in immature rabbits. Abnormal roentgenologic features within the femoral head are observed infrequently between five and ten weeks after dislocation, despite the high incidence of aseptic necrosis.

Animals↗
PubMed2005

Closed reduction of prosthetic hip dislocation by emergency physicians.

OBJECTIVE: The purpose of this study was to determine the frequency of successful closed reduction (CR) of dislocated prosthetic hips performed by emergency physicians (EPs) as well as the incidence of acute complications. METHODS: The study design was an explicit chart review set at an academic ED with an annual census of 55,000. The study was performed on March 1, 1999 to February 28, 2004. Patients were identified using coded ED diagnoses, and data were obtained by a trained abstractor. RESULTS: One hundred twelve dislocations in 66 patients had attempted CR in the ED. Eighty-one had CR attempted solely by an EP with 91% success. Twenty-eight of the remaining 31 (90%) had successful CR performed by either an orthopedic surgeon or both an EP and an orthopedic surgeon. Overall, 10 patients (9%) failed ED CR. No postreduction complications were identified in any patient. CONCLUSIONS: EPs can safely and successfully perform CR on patients with dislocated total hip arthroplasties.

Adult↗
PubMed1999

[Hip dislocation. Organization of screening and follow-up].

Early detection and low-risk treatment are the two main objectives of the management of developmental dislocation of the hip. The best way to evaluate neonatal hips is to perform clinical and ultrasound examinations at the same time, and to confront their results. Early diagnosis allows to restrict treatment to infants with neonatal dislocation who do not improve by 4 weeks of age. On the other hand, neonates with reductible dislocated hips must be treated at birth and followed at the joint consultation. Early diagnosis and management must not decrease later efforts to detect dislocated hip until walking age.

Follow-Up Studies↗
PubMed1989

Congenital hip dislocation: techniques for primary open reduction including femoral shortening.

Combining primary open reduction, femoral shortening, capsulorrhaphy, and acetabuloplasty in a single operation allows predictable treatment of congenital dislocation of the hip in older children without the time and expense of preliminary traction. In addition to the bony abnormalities of congenital hip dislocation, the complex pathologic anatomy of the hypertrophied capsule and associated soft tissues must be recognized and corrected. Failure to treat all components of this condition often leads to reduction that is apparently satisfactory in the intraoperative and early postoperative periods but is followed by hip subluxation or redislocation with weightbearing. Correcting all components of the congenital hip dislocation deformity in a single operation provides the best opportunity for early return of normal hip mechanics and function in the older child.

Acetabulum↗
PubMed2005

Neglected traumatic hip dislocation in children.

Traumatic dislocation of the hip in children is a rare injury. We report the outcome of open reduction of neglected traumatic posterior hip dislocation in 18 children. All patients had posterior dislocation and no associated fracture. They presented to the hospital because of persisting pain, deformity, and limp that were present for a mean period of 16 weeks after injury (range, 6-52 weeks). Open reduction was done in all patients because none of the hips could be reduced by skeletal traction in abduction. All of the hips had varying degrees of avascular necrosis (osteonecrosis), with preservation of joint space as seen on radiographs. At short term followup, seventeen children had an excellent functional outcome. We suggest that open reduction is a satisfactory treatment for neglected hip dislocation in children because an anatomically placed femoral head maintains the stimulus for growth of the pelvis and the femur. It prevents deformity and maintains limb length.

Bone Wires↗
PubMed1987

Bilateral traumatic hip dislocation.

An unusual bilateral hip dislocation in a 19-year-old female is presented, with a left Type III posterior fracture-dislocation (Thompson and Epstein) and a right Type V posterior dislocation (Thompson and Epstein's classification as modified by Pipkin's criteria). Open treatment with screw fixation, and removal of a fragment of the right femoral head that had been sheared off, avoided a long period of immobilization in this young woman.

Accidents, Traffic↗
PubMed1986

Posterior hip dislocation, a new technique for reduction.

Acute posterior hip dislocation is a common and serious orthopaedic problem. Key features of a new technique for the closed reduction of both posttraumatic and artificial posteriorly dislocated hips include the lateral decubitus position, exaggeration of the deformity (hip flexion 100 degrees, internal rotation to 45 degrees, adduction to 45 degrees), palpation of the dislocated femoral head and greater trochanter and gravity-assisted reduction, utilizing a simultaneous push-pull maneuver. The technique has been successfully employed in 18 awake but sedated patients, requiring the help of only one assistant. It has proven to be simple, effective, and complication free.

Hip Dislocation↗
PubMed1997

[Treatment of congenital hip dislocation using Pavlik's harness. Long term results].

PURPOSE OF THE STUDY: After many years using Pavlik harness for treatment of congenital hips dislocation, it is important to evaluate long-term results, failure causes and factors responsible for avascular necrosis. MATERIAL: One hundred and forty one children were treated by this mean (159 dislocated hips, 30 acetabular dysplasia). The follow up was 74 months (12-175). METHODS: In this study, the severity of the dislocation was evaluated by antero-posterior radiographs of the pelvis. The importance of proximal dislocation was measured by the distance from the top of the proximal femoral metaphysis to the Y line and the lateralization by the distance from the medial border of the proximal femoral metaphysis to the ischium. Results were appreciated using Severin classification modified by Kasser and Mose's circles. Several factors as age at the beginning of treatment, sex, previous treatment, passive abduction of the hip, amount of dislocation were statistically evaluated (chi 2 and P test). RESULTS: Of 159 dislocated hips, 10 (6.3 per cent) were not reduced by the harness. Temporary growth modifications and avascular necrosis were observed in 24 (16.1 per cent) of 149 reduced hips. We shall add to these, 3 avascular necrosis in 10 hips which were not reduced in the pavlik harness and 2 avascular necrosis which occurred in normal hips. This complication was not encountered in dysplasic hips without dislocation. Using Severin classification, there was 61 excellent, 33 good and 5 fair results in the group of 99 hips followed for more than 72 months. Of all growth anomalies and avascular necrosis, only half of them keep sequelae at the last follow-up. DISCUSSION: Some factors as age, sex, previous treatment have no incidence in the number of failures and avascular necrosis. On the contrary, passive abduction of the hip, severity of the dislocation were responsible for most of these complications. Pavlik harness must be used with circonspection. It can be used only where passive abduction is superior to 30 degrees and distance H superior to 4 mm. In other cases, it is preferable to use progressive traction. CONCLUSION: Pavlik harness is widely used for treatment of congenital hip dislocation. Reduction can be obtained as stabilisation and correction of acetabular dysplasia. The risk for avascular remains relatively high. The use of the harness needs a rigourous choice of indications.

Age Factors↗
PubMed2000

Initial treatment of traumatic hip dislocations in the adult.

The initial treatment of traumatic hip dislocations is critical to successful treatment of this injury. It generally is agreed that prompt reduction with the patient under anesthesia or sedation is required. Delay in reduction of posterior hip dislocations is associated with avascular necrosis of the hip. Occasionally the hip dislocation will be irreducible. Various methods to reduce hip dislocations have been described in the literature. The superiority of one particular technique has not been shown and the choice of reduction maneuver must be tailored to the condition of the patient. Traumatic hip dislocations often are associated with multiple injuries that may limit the options available for initial treatment of the hip dislocation. Adherence to general principles of skeletal reduction will increase the ease of reduction and decrease the risk of iatrogenic injury during reduction. Additional clinical and radiographic evaluation of the hip that was reduced often is necessary to determine whether subsequent open treatment is required.

Adult↗
PubMedDate not supplied

The associated effects of untreated unilateral hip dislocation in cerebral palsy scoliosis.

INTRODUCTION: The presence of a unilateral hip dislocation in children with cerebral palsy (CP) may cause problems with sitting imbalance, pressure ulcers, and hip pain. There is a dynamic interplay between hip dislocation, pelvic obliquity (PO), and scoliosis. The effect of an untreated unilateral hip dislocation on the rate of curve progression of CP scoliosis has not been defined in the literature. The purpose of this study is to investigate the effect of unilateral hip dislocation on PO and the rate of curve progression in children with spastic quadriplegic CP. METHODS: Patients with spastic quadriplegic CP who had spine radiographs at the time of initial presentation with scoliosis and at the latest follow-up were evaluated. Twenty-three children with spastic CP who had an untreated unilateral hip dislocation and scoliosis constituted the study group. The control group consisted of 83 quadriplegic CP patients with scoliosis and well-located hips. The rate of curve progression, incidence of PO, and the rate of PO progression at follow-up were compared between the 2 groups. RESULTS: The mean ages of patients with a unilateral dislocation and with well-located hips at initial radiograph were 10.4 and 10.5 years, respectively. The mean follow-up was 3.5 years. The mean rate of scoliosis curve progression in patients with a unilateral hip dislocation was 12.9 degrees per year. In the control group, the mean progression rate was 12.2 degrees per year. The incidence of PO at follow-up was 74% in scoliotic patients with a dislocation and 63% in scoliotic patients with normal hips. Using repeated-measures analysis of variance, unilateral hip dislocation was found to have no significant effect on scoliosis progression; however, progression of PO was significantly increased in the hip dislocation group (P < 0.05). Pelvic obliquity was corrected after posterior spinal fusion to the sacrum with pelvic fixation, without reducing the hip(s) at the same surgery. CONCLUSION: Unilateral hip dislocation causes a significant increase of PO but does not affect the rate of scoliosis curve progression.

Adolescent↗
PubMed1996

Femoral shortening in total arthroplasty for completely dislocated hips: 3-7 year results in 25 cases.

During the years 1988-1991, we performed 25 total hip replacements for completely dislocated hips in 15 women and 4 men with a median age of 54 (17-67) years. In all cases, femoral shortening at the subtrochanteric level was performed to obtain reduction of the hip. The patients have been followed for 3-7 years. 1 patient experienced sciatic nerve palsy, 1 a delayed union and 1 a malunion at the osteotomy site. There were no signs of mechanical failure. All patients were satisfied. According to the Charnley hip score, function was excellent in 15 cases, good in 9 and fair in 1. The median Harris hip score improved from 43 at the time of operation to 93 at follow-up. 7 hips had a positive and 18 a negative Trendelenburg test. Before operation, all patients had a Trendelenburg limp. Our intermediate results indicate that femoral shortening at the subtrochanteric level is a suitable adjunct to total arthroplasty for a completely dislocated hip.

Adolescent↗
PubMedDate not supplied

[Magnetic resonance tomography in diagnosis and therapy follow-up of patients with congenital hip dysplasia and hip dislocation].

AIM: In patients with congenital dislocation of the hip the assessment of the correct position of the hip joint after closed or open reduction is very difficult to make from the radiograph with the hips in plaster. As the delayed recognition of a recurrent hip dislocation has bad effects on the outcome of the affected hip a safe and reliable imaging method must be employed. METHOD: From 1993 to 1996 6 patients with 8 congenital dislocations of the hip joint were examined by magnetic resonance imaging for evaluation of the position of the hip in plaster after reduction. Magnetic resonance imaging was performed immediately after closed or open reduction. 3 hips had to be treated by open surgery. RESULTS: The investigation confirmed that magnetic resonance imaging allows perfect differentiation between the bony and cartilaginous parts of the hip joint in plaster as well. Interpositioning of soft tissues which prevent reduction could also be visualized clearly. The best sequence in order to differentiate bony from cartilaginous structures was a gradient echo sequence in flash-technique using a flip-angle of 60 degrees. In all cases the correct position of the hip joint after reduction could be demonstrated in plaster. CONCLUSION: Therefore, magnetic resonance imaging is the imaging method of choice for confirmation and documentation of the reduced position of the hip joint in plaster. Radiographs are no longer needed.

Cartilage, Articular↗
PubMed2002

Traumatic hip dislocation in athletes.

Sports injuries are increasingly prevalent. Dislocations of the hip are rare; however, they are seen in high-velocity sports such as football and rugby. The injuries may be described as anterior or posterior, and classified according to severity of injury. It is critical to the sports medicine practitioner to promptly recognize and manage this complex injury. This article presents a functional management algorithm including reduction techniques for the simple hip dislocation. Early reduction minimizes complications in all studies. Immediate on-field reduction has been performed successfully and safely in a limited number of cases. An aggressive rehabilitation protocol is proposed to assist the athlete back to sporting activity as soon as possible. The potential benefits of early reduction limit the risk of avascular necrosis of the femoral head and sciatic neuropathy; therefore, further investigation into the standard use of this immediate reduction technique is warranted.

Athletic Injuries↗
PubMed2005

Aplasia of the pubic bone in conjunction with hip dislocation.

We describe here unilateral left hip dislocation in a 2-year-old child in conjunction with ipsilateral absence of the pubic bone. He was admitted to our hospital at 1 year of age and diagnosed with teratogenic dislocation of the left hip, aplasia of the left pubic bone, an undescended palpable left testicle and hypospadias. We performed open reduction through an anterior approach with preliminary skin traction for 1 week and spica cast for 3 months. The acetabular index was high both on admission and in the last radiographic control. Computerized tomography demonstrated dysplasia of the acetabulum and absence of the pubic bone. We concluded that the congenital absence of the left pubis was the major cause of the residual acetabular dysplasia. To our knowledge the conjunction of hip dislocation, aplasia of pubic bone and genitourinary anomalies has not been reported in the orthopaedic literature previously.

Acetabulum↗
PubMed2007

Results on total hip arthroplasties with femoral shortening for Crowe's group IV dislocated hips.

We performed total hip arthroplasties in 11 women with Crowe's group IV completely dislocated hips, with a mean age at surgery of 59.6 years and a mean follow-up of 65 months. In all cases, femoral shortening was achieved using step-cut osteotomy. All acetabular cups were placed in their anatomical locations. The mean Merle d'Aubigne hip score improved from 10.9 points to 16.9. There was no case of nonunion or malunion in the osteotomized site. Temporary numbness was observed in 2 hips, which subsided within 3 weeks without any treatment. One hip had to be revised 8 years after surgery because of aseptic loosening of the stem. Our study shows that total hip arthroplasty, incorporating step-cut femoral shortening, provides acceptable results for completely dislocated hip.

Adult↗