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PubMedDate not supplied

Developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH), formerly known as congenital dislocation of the hip (CDH), is a term used to describe a variety of abnormalities of the hip in development. The treatment options are diverse depending on etiology, degree of dislocation, and age of the child when diagnosis is made. This article provides the reader with a knowledge base to assist with early diagnosis, treatment, and nursing care of the client with dislocations and subluxations of the hip. Presented are the definitions, diagnostic techniques, treatments, and nursing diagnoses and interventions for the client with DDH and for the child's family.

Braces↗
PubMed1992

[Hip diseases in children].

In the orthopedic practice, the hip joint is of special importance at all ages. For the general practitioner and the pediatrician are those disorders of the hip of high importance, for which early diagnosis and initiation of treatment is critical for prognosis. The following disorders should be looked for in priority, if symptoms indicate a possible affection of hip: congenital dysplasia and dislocation of the hip, coxitis, slipped capital femoral epiphysis, and tumors. One should always be aware that especially in children disease of the hip need not necessarily present with symptoms directly located within the region of the hip. Especially the child often complains only about knee or vague leg pain, while having a disorder of the hip; therefore, the cause of any pain should always also be looked for proximal to the structure, where the pain may be localized by the patient.

Bone Neoplasms↗
PubMed1980

Intra-articular volume and hip joint instability in dogs with hip dysplasia.

UNLABELLED: The nature of the instability of the hip joint in dogs with dysplasia of the hip was investigated. In the experimental canine model, instability of the joint, as shown by subluxation of the femoral head on a roentgenogram, was accompanied by an increase in the volume of the synovial fluid and of the ligamentum teres and, therefore, an increase in the intra-articular volume. Injection of a buffered solution of hyaluronic acid into non-subluxated hip joints in situ increased subluxation, whereas withdrawal of synovial fluid from one joint with severe subluxation reduced the degree of subluxation. The withdrawal of varying amounts of synovial fluid from excised but intact joints resulted in a decrease in the lateral displacement of the femoral heads. Injection of the hyaluronic acid solution into excised joints resulted in increased lateral displacement of the femoral heads. The results suggest that the joint instability associated with canine hip dysplasia is related to increased intra-articular volume. CLINICAL RELEVANCE: Instability of the hip joint (abnormal laxity) is a feature of hip dysplasia in dogs and congenital dislocation of the hip in children. The canine disease can provide a valuable model in which to examine the pathogenesis of hip instability. The model may be useful to test prophylactic procedures to prevent joint instability and thus ameliorate disease.

Animals↗
PubMed1988

The predictability of acetabular development after closed reduction for congenital dislocation of the hip.

We have reviewed the serial radiographs of 63 hips in 53 children treated by closed reduction for congenital dislocation with a view to finding a radiological measurement which can predict subsequent acetabular development. All had been followed for more than seven years, and at latest review, 34 hips were dysplastic. Failure to obtain concentric reduction or its loss by migration of the femoral head within one year of reduction were the best predictors of persisting acetabular dysplasia and were best quantitated by the h/b ratio (Smith et al. 1968). The acetabular index at reduction or its decrease in the first year were not reliable predictors. Late treatment was less likely to lead to normal acetabular development, but avascular necrosis did not appear to have a significant influence. The average age at which the acetabulum stopped developing was five years, but ranged from 17 months to eight years. The failure of a dysplastic acetabulum to improve in each annual radiograph after closed reduction should lead to consideration of operation on the acetabulum.

Acetabulum↗
PubMed1980

Detection of congenital dislocation of the hip by an early screening program, with particular reference to false negatives.

The incidence of hip abnormality was investigated in 11,980 children born at Hope Hospital, Salford, between 1975 and 1978. Of 179 neonates (14.9/1,000 livebirths) found to have an abnormal hip, only 22 (1.8/1,000 livebirths) required treatment with an abduction splint. Despite this high detection rate of hip abnormalities, 10 children (0.83/1,000 livebirths) presented with late congenital dislocation of the hip, i.e., CDH diagnosed after the age of six weeks. It is suggested that the hips should be reexamined in all children at the age of six to seven months.

England↗
PubMedDate not supplied

[Primary ultrasonic diagnosis of congenital hip dysplasia in neonates at the Senta Hospital].

INTRODUCTION: Congenital hip dislocation is an abnormality which has not been managed in the period of early infantile period. However, clinical and ultrasound screening performed in the first days of life after birth at the Labor and Delivery Departments, provide prompt application of certain preventive and therapeutic measures which are painless, nonaggressive and highly efficient at this age. That is why primary sonoscreening of congenital hip dislocation of newborn infants in the first three days of life has been introduced at the Labor and Delivery Department of the Hospital in Senta. Methodology after Graf using a 5 Mhz linear probe is applied. Examinations are performed in the lateral position, giving a morphological finding, whereas morphodynamic data are processed after Graf classification. In clinically unstable and sonographically critical hips a dynamic hip examination is performed after Harcke. This is a teamwork of a neonatologist, ultrasonographist and child orthopedist and management of pathological hips starts at our department. Depending on indications therapeutic panties. Pavlik harness or Von Rosen band are used. Mothers are instructed how to use these appliances and take care of their newborn infants in these circumstances which helps in accepting the necessary therapeutic procedures. RESULTS: In the period 1991-1998, 14,378 hips were examined at the Labor and Delivery Department of the Hospital in Senta. A normal sonographic finding of Ia type was found in 45.87% of hips, while Ib type was found in 18.58% of hips. There were 31.16% of sonographically immature hips of IIa plus type, whereas a pathological finding was found in 1.39% of hips. In this group of pathological hips there were 0.98% of sonographically critical hips of IIg type. 0.26% of sonographically decentered hips of IID type. 0.09% of decentered hips of IIIa type and 0.06% excentric hips of type IV after Graf. In pathologic hips, check-ups were performed every 3 weeks and every 6 weeks in sonographically immature hips. CONCLUSION: Considering the fact that the first three months are the period of the most intensive maturation, that is the phase of absolute reduction of excentric and decentered hip in newborn infants, check-ups for infants with normal hip clinical and ultrasonographic findings were obligatory after the third month. Results of early nontraumatic and dynamic treatment proved successful on the basis of control clinical, functional, ultrasonographic and radiographic parameters. During the studied period at our territory there were no cases with aseptic necrosis of femoral head, nor necessity for surgical correction of the congenital hip dislocation.

Female↗
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↗
PubMed1980

A comparative evaluation of the current methods for open reduction of the congenitally displaced hip.

The history of open reduction for congenital dislocation of the hips is reviewed. There are currently five procedures used for open reduction of the hip. Each of these procedures is reviewed as to rationale, anatomic approach, and advantages. An attempt is made to review the literature concerning the complications and results associated with these various procedures. The author concludes by attempting to formulate the indications for each of the five procedures.

Acetabulum↗
PubMed2000

A new technique of subtrochanteric shortening in total hip arthroplasty: surgical technique and results of 9 cases.

Total hip arthroplasty for severe chronic proximal femoral migration, most commonly seen in congenital dislocation of the hip, has been associated with high rates of complications. A new technique of femoral subtrochanteric shortening osteotomy with the prosthesis in situ is described. This technique minimizes the potential complications, allows for correction of severe femoral neck anteversion, and gives excellent rotational stability, while preserving the proximal femur for better press-fit cementless fixation. In this series, there were 9 cases: 6 women and 2 men with a mean age of 53 years (range, 26-77 years). The average follow-up period was 56 months (range, 6-86 months). The mean preoperative Harris Hip Score was 31 (range, 20-35), and the mean postoperative score was 81 (range, 60-98). At follow-up, all patients reported significant pain relief and functional improvement. All osteotomies appeared to be healed on radiographs by 12 weeks. There were 3 complications. The first complication was a recurrent dislocation resulting from muscle incompetence, which was revised using a constrained liner and a 32-mm head with no further dislocations. The second complication was a breach of the femoral shaft, which was treated operatively using a longer stem. The third complication was a proximal femoral shaft split, which was treated by leaving the cerclage wire in situ. This technique should be considered in cases of congenital dislocation of the hip and when femoral shortening is needed.

Adult↗
PubMed2003

[Screening of congenital dislocation of the hip in the newborn. A systematic and rigorous clinical examination. A restricted use of imaging].

(1) Clinical examination of the hips should be systematically performed in the newborn, in order to detect a possible congenital dislocation. This translates into hip joint instability, which can be evidenced by both Ortolani's and Barlow's signs, the latter being more sensitive. Special attention should be paid for abduction range, as limited abduction is a warning sign. (2) Use of imaging, especially sonography will be restricted to specific cases only. It's prescription, technical realization as well as interpretation have to be carefully done, so that it is actually relevant to uncertain or "at risk" situations. (3) Treatment if needed, should be ideally managed by a paediatric orthopaedic surgeon.

Diagnosis, Differential↗
PubMedDate not supplied

Pattern of congenital orthopaedic malformations in an African teaching hospital.

BACKGROUND: Congenital Orthopaedic malformations are common malformations that are usually unacceptable to the common populace in the West African sub-region. There is paucity of knowledge about the common types of Orthopaedic congenital malformations in our environment This study was undertaken to determine the pattern of congenital Orthopaedic malformations in a Teaching Hospital. STUDY DESIGN: This was a prospective study of all the Orthopaedic congenital malformations seen in our surgical outpatient departments and the inpatient referrals from the wards between January 1995 and December 2003. RESULT: There were 284 patients in total with a male to female ratio of 2:1 and age range between two days to nine years. Clubfoot (CTEV) accounted for 52.8% of all the malformations while Congenital knee dislocation (CDK) and calcaneovalgus deformity accounted for 8%. Congenital hip dislocation (CDH) accounted for only 2.2% of all the cases. CONCLUSION: Congenital talipes equinovarus deformity is the most common congenital orthopaedic malformation in this environment while congenital hip dislocation (CDH) is rare when compared with the Caucasians.

Calcaneus↗
PubMed1986

Sonography in congenital dislocation of the hip.

A new technique for ultrasonic examination of the hip joint was evaluated in neonatals and infants. An anterior approach was used with the sound sector centered over the femoral head and parallel to the femoral neck. The ultrasonograms corresponded to lateral radiographs of the joint with the leg in Lorenz' first position. It was possible to evaluate the size and depth of the acetabulum and the size and position of the femoral head. The projection also permitted a dynamic examination for determination of hip instability. Thus, the technique provided a method for an objective diagnosis in congenital dislocation of the hip (CDH). In 216 hips, the results of clinical evaluation for CDH were correlated with the degree of instability demonstrated by ultrasound. The comparison showed the clinical diagnosis to be highly inaccurate.

Evaluation Studies as Topic↗