[Risk factors during the intrauterine stage predisposing to congenital hip dislocation].
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Between 1976 and 1987, 85 cases of CDH occurring after walking age were followed in the department. Eighteen children aged 5 years or older were reviewed. In 11 children the dislocation was unilateral and in 7 bilateral; out of these 25 hips, 20 were high luxations and 5 occurred at a lower level. Two children, 6 and 13 years old, had a bilateral dislocation. Except for 2 children of 5 years of age who were treated conservatively, surgical treatment was indicated in the other 18 cases usually after tenotomy and derotation. In 13 hips, a surgical repositioning was performed, associated with femoral osteotomies, either shortening osteotomies (7) or derotation osteotomies (3). Pelvic osteotomies were indicated either immediately or later in 15 hips. A triple osteotomy was usually performed (11); a Salter (2) or a Chiari (2) has been rarely used. After a follow-up of 5 years, evaluation according to clinical and radiological criteria showed 14 good and 7 bad results. The latter 7 cases had either a dislocation or an eccentration. Reviewing these series, the authors describe the problems in the treatment of the dislocated hip in the older child: the indications, the therapeutic strategy for those dislocations and the decision for treatment of the bilateral high dislocation in the older child.
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The authors inform about dangerous complications in the children with cerebral palsy-secondary dysplasia, subluxation or luxation of the hip. Among 326 children treated in the Orthopaedic Paediatric Department in Lublin in the years 1993-1996, 67 children had problems with hips. Paralytic hip luxation leads to the loss of walking abilities among many children. The operative reconstruction of the hip luxation is very difficult and does not allow the complete rebuilding of the joint.
The authors make an analysis of results of operations for open setting with capsular arthroplasty of the hip joint, derotational supratrochanteric denticulate osteotomy and resection of the femur with creation of iliofemoral, ischiofemoral and pubofemoral ligaments from the residual proximal part of the capsule in 56 children with congenital dislocation of the femur. Long-term results were studied in 46 children, 35 of them having good results and 8 having satisfactory results.
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The authors report an analysis of the results obtained after conservative therapy for femoral dislocations. Reduction of luxations was accomplished after the Djanalidze and Kocher method with subsequent immobilization of the extremity by means of skeletal extension, plaster cast and bandaging one leg to the other. The results proved to be different depending on the technic of reduction employed, fixation of the extremity and its duration, and the start of the weight-bearing on the injured extremity. Some recommendations on prophylaxis of arthroses immediately after femoral dislocation are given.