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At least 1,225 records · Page 68Linked to original sources
PubMed1993

Acetabular development after closed reduction of congenital dislocation of the hip.

We reviewed the serial radiographs of 54 hips in 47 children treated by closed reduction for congenital dislocation of the hip and followed to at least 14 years of age, to determine the causes of acetabular dysplasia. We excluded hips with femoral head deformity or residual subluxation and compared the results with those from a control series of unaffected hips of patients with unilateral CDH. Acetabular development after the age of 11 or 12 years was significantly worse in Severin group III than in Severin group I hips on the affected side or Severin group III in unaffected control hips. One of the causes of acetabular dysplasia at maturity was found to be impairment of acetabular development after 11 or 12 years of age. This may be attributable to impaired secondary ossification in the acetabular rim. Our findings emphasise the importance of continuing the follow-up of patients treated for congenital dislocation of the hip until full skeletal maturity.

Acetabulum↗
PubMed1996

Clinical screening for congenital dislocation of the hip.

The hips of 20,417 newborns were examined within the first three days after birth and at the age of two to three months, from 1985 to 1990. One hundred and twenty-four children had abnormal findings in one or both hips and treatment was instituted. After an average duration of follow-up of six years (range, four to nine years), 122 (98 per cent) of the children had normally developed hip joints. One child had unilateral deformity of the femoral head due to ischemia, and another had bilateral anteversion as the only abnormal finding. A survey of the medical records of the only orthopaedic clinic in Stara Zagora that has a pediatric ward in which patients with hip problems are managed revealed no cases of congenital dislocation of the hip diagnosed after the age of three months in the infants born from 1985 to 1990. Clinical screening for congenital dislocation of the hip was effective in this group of patients, and a good result was noted in all but two patients who were treated for such a dislocation. Thus, a screening program is of value in the examination of all infants.

Algorithms↗
PubMedDate not supplied

One-stage treatment of congenital dislocation of the hip in older children.

We reviewed the results of a primary one-stage combined operation in 47 patients (55 hips) who were > or = 4 years and had congenital dislocation of the hip. At a mean follow-up of 7.5 years (2-16 years), 67% of the whole series had good or excellent clinical results, and 65% were good or excellent radiologically. Avascular necrosis occurred in four patients, and redislocation also occurred in four patients. We concluded that most of the children who are > or = 4 years and who have congenital dislocation of the hip can successfully be treated with an extensive one-stage operation consisting of open reduction combined with innominate osteotomy and femoral varus, derotation, and shortening osteotomy.

Adolescent↗
PubMedDate not supplied

[Luxation of the hip and preventive examinations].

The present report on the possibilities and limitations of screening and its importance for the prevention of congenital hip dislocation is based on many years of practical experience in preventive medicine and equally extensive study of oblique presentation and congenital dislocation of the hip joint. The paper presents a review of the various forms of malformation of the hip and following a short discussion of the origins and prognoses of these various forms, deals with the various diagnoses. Two main examination periods are important for diagnosis: the neonatal period and the 4th month of life. In the neonatal period a hip joint is unstable if the Roser-Ortolani sign is positive. Other clinical symptoms are found in addition in the much rarer congenital dislocation of the hip. The advantage of examination in the neonatal period is that it enables the unstable hip joint to be treated immediately. As a rule this preventive treatment, involving little risk, results in normal development of the hip joint, instead of the possible defective development to hip dislocation. These possibilities in the neonatal period are limited by the degree of experience and the extent of cooperation between examiners and therapists. In the second main examination period, in the 4th month of life, the malformations which occur post partum should be identified. In contrast to the obviousness of the clinical hip joint findings in the neonatal period" clear clinical hip joint symptoms can only be expected in the 4th month of life with the most severe forms of hip dislocation.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

The surgical treatment of established congenital dislocation of the hip: results of surgery after planned delayed intervention following the appearance of the capital femoral ossific nucleus.

It has been proposed that the presence of the capital femoral ossific nucleus confers protection against ischemic injury or avascular necrosis (AVN) at the time of reduction of a congenitally dislocated hip. The current literature is contradictory. A prospective study was undertaken of the clinical and radiologic outcomes following closed or open reduction. Fifty hips were included in the study. These cases had presented late or had failed conservative treatment. In 28 hips treatment was intentionally delayed until the appearance of the ossific nucleus (but not beyond 13 months) and in 22 the ossific nucleus was present at clinical presentation. Six hips reached the age of 13 months without an ossific nucleus appearing and progressed to treatment. The significant AVN rate (more than grade 1) was 7% for closed reduction and 14% for open. However, the amended rate if hips were excluded that had failed Pavlik harness treatment was 0.0% and 9%, respectively (4% overall). Further surgical procedures were necessary in 57% of hips undergoing closed reduction and 41% after open, which compares favorably with other series. The authors conclude that the presence of the ossific nucleus is an important factor in the prevention of AVN, particularly after late closed reduction. Intentional delay in the timing of surgery does not condemn a hip to open surgery, but there is a comparable rate of secondary procedures becoming necessary, particularly after closed reduction. A simultaneous pelvic procedure may be appropriate after late closed reduction. The delayed strategy to await the appearance of the ossific nucleus for previously untreated dislocation allows a simple treatment algorithm to be employed that produces good clinical and radiologic outcomes.

Female↗
PubMed1992

[Echography in the study of the neonatal hip: the diagnostic-therapeutic implications of type-IIa (borderline) findings].

Sonography (US) is a useful method in the early diagnosis of congenital hip dislocation; X-ray examination exhibits limitations due to high false-positive and false-negative rates. The advantages of US include: non-invasiveness, direct visualization of muscle and cartilage, dynamic demonstration of anatomical structures, and possible diagnosis in neonatal age. Therefore, US can be used as a screening or targeted diagnostic technique in selected newborns with clinical suspicion and/or risk factors. In this paper the authors report their experience in 1271 patients (721 females, 550 males), aged 1 day to 7 months, who were examined with US for the diagnosis of congenital hip dislocation. The newborns were divided into two groups at first examination: a) the screening group included 524 consecutive newborns (F = 266, M = 258) from S. Chiara Regional Hospital in Trento, and b) a selected group of 747 newborns (F = 455, M = 292) with clinical suspicion and/or risk factors, who had been selected in the Trento area. According to Graf's classification, the results of US in 2542 neonatal hips, were: 2346 (92.3%) normal hips, 171 (6.1%) type IIa hips, and 24 (1.6%) pathological hips. In the selected group (1494 hips) we observed: 1351 (90.4%) normal, 119 (8%) type IIa, and 24 (1.6%) pathological hips (IIb, IIc, D, III). In the screening group (1048 hips) we detected: 995 (95%) normal hips (Ia/Ib), 52 (4.9%) type IIa, and 1 (0.1%) pathological hips (D). Our experience suggests that US is a useful method in selected newborns with clinical suspicion of congenital hip dislocation and/or risk factors. US limitations consists in the dispersion of type IIa hips. Moreover, the need emerged for complete cooperation between pediatrician, radiologist, and orthopedist to optimize the cost/benefit ratio.

Female↗
PubMed1989

One-stage treatment of congenital dislocation of the hip in older children, including femoral shortening.

We reviewed the results of primary operative treatment in twenty-five patients (thirty-three hips) who were two years or older and had congenital dislocation of the hip. None of the patients had had previous treatment for the dislocation. Preliminary traction was not used in any patient. Femoral shortening and, in twenty-one hips, pelvic osteotomy were performed at the time of open reduction. At the most recent follow-up (average, three years and seven months), according to the radiographic classification system of Severin, there were seven excellent, seventeen good, and eight fair results; one hip had a poor result. Avascular necrosis developed in three of the thirty-three hips. At follow-up, these hips had a radiographic result of excellent, good, and fair, respectively. Twenty-one patients (twenty-eight hips) were reviewed with respect to range of motion and recovery from limb-length discrepancy. According to the rating system of Ferguson and Howorth, there were seventeen excellent, seven good, and three fair results; one hip had a poor result. It was concluded that children who are two years or older and who have a congenital dislocation of the hip can safely be treated with an extensive one-stage operation consisting of open reduction combined with femoral shortening and, often, pelvic osteotomy, without increasing the risk of avascular necrosis. The limb-length discrepancy that is produced by the shortening does not appear to cause a clinical problem.

Child↗
PubMed1980

The medial approach in congenital dislocation of the hip.

From January 1970 to January 1979, 50 hips in 39 patients were operated on for congenital dislocation of the hip at the University of Iowa. Each hip was evaluated for acetabular development, aseptic necrosis and subluxation; arthrograms were correlated with intraoperative findings. Aseptic necrosis occurred in two patients (5%). Intraarticular obstacles to reduction are described. Acetabular development progressed rapidly once concentric reduction was obtained. The medial approach provided a safe, effective way to reduce dislocated hips in infancy. We advocate this procedure when a concentric reduction cannot be obtained by closed manipulation or when the reduction is considered unstable.

Acetabulum↗
PubMed2004

[A comparison between the use of a monolateral external fixator and the Ilizarov technique for pelvic support osteotomies].

OBJECTIVES: We compared the results of monolateral external fixator and the Ilizarov technique for pelvic support osteotomies in the treatment of neglected congenital hip dislocation. METHODS: Seventeen female patients with congenital dislocation of the hip underwent pelvic support osteotomy using a monolateral external fixator (MEF) (n=7; mean age 23.2 years; range 17 to 39 years) or the hybrid advanced Ilizarov method (HAIM) (n=10; mean age 25.9 years; range 17 to 36 years). The mean leg discrepancies, durations of the external fixator, and follow up-periods in the MEF and HAIM groups were as follows, respectively: 5.5 cm and 5.2 cm; 201.5 days (range 185 to 241 days) and 197 days (164 to 248 days); 30.4 months (23 to 39 months) and 40.5 months (21 to 65 months). The two groups were compared with respect to patients' discomfort related to the use of external fixators and pin tract infections classified according to the Paley criteria. RESULTS: Overall, six pins required removal because of grade 3 pin track infections (5 in the HAIM group, 1 in the MEF group). The number of patients who reported extreme discomfort for the use of external fixator was three in the HAIM group and one in the MEF group. Although the range of motion of the knee was similar in both groups (p>0.05), clinically, patients treated with MEF exhibited a more comfortable range of motion of the knee with external fixation and, after removal of the fixator, reached a knee flexion of 90 degrees in a shorter time (36 days versus 47 days). CONCLUSION: The use of MEF for pelvic support osteotomies seems to be preferable because it is associated with a lower rate of pin tract infections and a higher degree of patient comfort.

Adolescent↗
PubMed1984

Avascular necrosis of the femoral heads following bilateral iliopsoas and adductor releases via the medical approach to the hip.

The medial approach to the hip is commonly used for open reduction of a congenitally dislocated hip, and cases of avascular necrosis have been reported following this operation. This approach has also been used for iliopsoas releases, but the complication of avascular necrosis has not been previously reported for this particular procedure. We present a case of bilateral avascular necrosis following bilateral iliopsoas releases in a patient with cerebral palsy. The likely etiology for the avascular necrosis of the hip was disruption of the medial femoral circumflex artery.

Femoral Artery↗
PubMed1980

Congenital dislocation of the hip. The fate of the well-developed acetabulum.

In a previous study of 177 hips treated in infancy for congenital dislocation and followed for 10 to 27 years, all were found to have well-developed acetabula. Nevertheless, there were two cases with minimal arthrotic changes. In this paper, a further study of 107 of these hips, with a follow-up of 15 to 30 years, indicates that the number of hips with arthrotic changes has increased. Attention was given to the fate of the acetabulum in relation to its depth or shallowness as measured by the CE angle. It is concluded that a hip with a slightly shallow acetabulum (CE angle, approximately 20 degrees) is less susceptible to wear or deterioration than a hip with a deeper acetabulum (CE angle, greater than 25 degrees).

Acetabulum↗