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PubMed1981

Congenital metacarpotalar syndrome.

Three children were presented having similar facies, musculoskeletal anomalies and a common ethnic background. All had dislocated hips, scoliosis, congenital vertical tali and hand deformities. There was a very small web space between the first and second metacarpals, extension deformities at the wrist, flexion deformities at the metacarpophalangeal joints, and at one or more proximal interphalangeal joints. In addition, 2 of the 3 youngsters had marked crowding of the teeth and a small maxillary arch. All laboratory studies were normal. The most alarming finding was the poor wound healing which averaged 48%. The wound complication rate at Shriner's Hospital in San Francisco during the identical period of time these children were treated ranged from 1.2% to 1.8%. It is believed that this represents a new syndrome, as similar cases could not be found in the literature. The orthopedist may treat these anomalies in the standard fashion but should keep in mind the propensity for poor wound healing in these patients. The common ethnic background was that of Spanish-American or Chicago families.

Abnormalities, Multiple↗
PubMed1998

The prognostic importance of the ossific nucleus in the treatment of congenital dysplasia of the hip.

Ischemic necrosis of the femoral head occurring after the treatment of congenital dysplasia of the hip can negatively affect the long-term prognosis of the involved hip. Some investigators have suggested that the presence of the ossific nucleus of the femoral head at the time of closed or open reduction is associated with a lower rate of ischemic necrosis. This finding, if verified, could lead to a delay in the treatment of a dislocated hip until ossification of the femoral head has begun, which may be well after the age when the patient has started to walk. We conducted a computerized search of the medical records at our two tertiary-care children's hospitals to identify all patients with congenital dysplasia of the hip who had had a closed or open reduction between January 1, 1979, and December 31, 1993. One hundred and twenty-four patients (153 hips) who satisfied the criteria for inclusion were identified. The ossific nucleus was present in ninety hips and absent in sixty-three. Closed reduction was used in 112 hips and open reduction, in forty-one. Ischemic necrosis was identified in five hips (3 percent): four (6 percent) of the sixty-three hips that did not have an ossific nucleus and one (1 percent) of the ninety hips that had an ossific nucleus at the time of the reduction. With the numbers available for study, we could not detect a difference between these two groups. The age at reduction (p > 0.99), the method of reduction (p = 0.611), previous treatment with a Pavlik harness (p = 0.592), the use of preliminary traction (p = 0.602), concomitant procedures (p > 0.99), and a failure of the primary closed reduction (p = 0.579) were not associated with the development of ischemic necrosis after reduction. In our analysis of patients who were managed over a fifteen-year period, the data did not support the hypothesis that the presence of an ossific nucleus at the time of reduction of a congenitally dislocated hip is associated with a lower prevalence of ischemic necrosis of the femoral head. Sound operative principles dictate that operative reduction of a congenitally displaced hip should be performed when the child can be safely placed under anesthesia and without regard to the presence or absence of the ossific nucleus.

Case-Control Studies↗
PubMedDate not supplied

Treatment of failed open reduction for congenital dislocation of the hip.

Twenty-three patients with 25 involved hips underwent repeat open reduction after previous unsuccessful attempts at open reduction for congenital dislocation of the hip (CDH). All hips ultimately were reduced at a mean age of 2 years 10 months (range 10 months to 7 years 3 months). On review, we noted that 15 of the hips were never concentrically reduced at the first procedure, and seven of these hips had undergone simultaneous Salter osteotomy. The most common cause of failure was improper exposure and release of the tight inferior capsule and transverse acetabular ligament, which blocked complete reduction. A vascular necrosis was documented in 44% of the hips, with a lateral physeal growth disturbance in four hips, a central physeal growth arrest in four hips, and complete femoral head necrosis in three hips.

Child↗
PubMed1991

Total hip replacement in the paleoacetabulum: biomechanical considerations.

The authors analyze the biomechanics of the dislocated hip in preparation to total hip replacement. Using the Pauwels criteria as a starting point, the authors observe the pathologic modification of this equilibrium when the hip is congenitally dislocated. Finally, applying these criteria to the acetabular component positioned in both the neoacetabulum and the true or paleoacetabulum, the authors show that the latter is biomechanically more advantageous.

Acetabulum↗
PubMed1995

Evaluating the national screening programme for congenital dislocation of the hip.

In 1969 universal clinical screening for neonatal hip instability was formally adopted in the United Kingdom with the aim of detecting and treating children considered to be at high risk of congenital dislocation of the hip (CDH). However, clinical screening is associated with both false positive and false negative diagnoses and has never been evaluated in a randomised trial. The emergence of hip ultrasound provides renewed impetus to reconsider and formally evaluate screening for CDH. Ultrasound imaging of the newborn hip may be used as a screening test and to assess and manage infants with clinically detected hip instability. Universal primary ultrasound screening has been adopted in some European countries, but enthusiasm for this new technology has been tempered by the subsequent large increases in treatment and follow up. This paper reviews the existing evidence to support the different approaches to screening and describes the research agenda of the MRC working party on congenital dislocation of the hip. A randomised trial of screening is required to evaluate the policy options before ultrasound screening becomes widely adopted within the United Kingdom. The feasibility and acceptability of a trial need to be explored and key issues relating to trial design addressed.

Evaluation Studies as Topic↗
PubMedDate not supplied

The Altdorf hip clamp.

Forty-one osteotomies internally fixed with the Altdorf hip clamp were reviewed at Nemours Children's Hospital (Jacksonville, FL). They were divided according to pathology: cerebral palsy, 19 patients; congenital dislocated hip, 2 patients; Legg-Calvé-Perthes disease, 8 patients; and other, 2 patients. There were 15 boys and 18 girls, with an average age of 6.9 years (range 2.6-12 years). No intraoperative complications have been reported. Long-term complications are as follows: nonunion, one patient; superficial wound infection, one patient; and loss of position of greater than 15 degrees, two patients.

Cerebral Palsy↗
PubMed1990

Avascular necrosis in patients treated with the Pavlik harness for congenital dislocation of the hip.

Two hundred and seventy hips of 220 patients were treated with the Pavlik harness for congenital dislocation. Two hundred and thirty-three hips were dislocated, and thirty-seven hips had acetabular dysplasia. Of the 233 dislocated hips, thirteen (6 per cent) were not reduced. In one hundred and eighty-four hips that were successfully reduced, avascular necrosis did not develop. Avascular necrosis was observed in thirty-six (16 per cent) of the 220 reduced hips. Of these, twenty-seven hips were followed for five to twenty years (average, nine years). The result was excellent or good in eighteen hips (67 per cent), fair in three (11 per cent), and a failure in six (22 per cent). Avascular necrosis was seen in one of the thirty-seven hips that had acetabular dysplasia, and it was found even in the normal hip of a patient who had unilateral dislocation. In this study, the amount of displacement was represented by distances a and b, as defined by Yamamuro and Chene. Distance a is the length from the middle point of the proximal metaphyseal border of the femur to the Y-line, and distance b is the distance from the same point to the lateral margin of the ischium. When distance a was more than four millimeters, the over-all rate of reduction was 97 per cent (209 of 215 hips), ranging from 96 per cent (eighty-two of eighty-five hips) when distance a was eight to ten millimeters to 100 per cent (twenty-nine hips) when distance a was more than ten millimeters.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗