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A lightweight, washable, and easily adjusted splint for the congenitally dislocated hip, designed to improve maternal compliance, is described. Observations are currently scientifically uncontrolled, though initial impressions are favourable.
A previous undescribed cause of ventriculoperitoneal shunt malfunction is presented. Limitation of abdominal excursion by a spica cast used to correct congenital hip dislocation reduced cerebrospinal fluid flow through a shunt. This easily correctable cause of "shunt failure" nearly resulted in replacement of a working shunt.
Between 1980 and 1983, 30 anterior approach open reductions were performed on congenitally dislocated hips of 29 patients after unsuccessful conservative treatment; patients were between 6 and 18 months old. After the removal of the obstruction from the acetabulum, the reduction was performed with preservation of the limbus. Some part of the capsule was removed to constrict and tighten it and to prevent redislocation. This capsuloplasty demonstrates the success of a Pavlik harness and abduction splint postoperatively, without plaster fixation. The accelerated development of the acetabulum could be observed on radiograph by this functional treatment, compared to the control group treated with the usual hip spica postoperatively. The development of the acetabulum on the operated side almost equals the sound side within a year. If the operation was performed earlier, joint development would be quicker.
PURPOSE OF THE STUDY: The aim of this work was to report our experience with arthroscopy for the treatment of acetabular labral lesions and identify prognostic factors determining mid- and long-term outcome. MATERIAL AND METHODS: Between August 1991 and December 1997, 12 patients (ten women, two men, mean age 39 years, age range 25-61 years) underwent arthroscopic treatment of an acetabular labrum lesion. All were reviewed at a mean 4 years follow-up (18 months-8 years). Half of the patients (n =6) had a history of hip surgery: two femoral osteotomies and one acetabular bone block for congenital hip dislocation, two high-energy traumas and one traumatic dislocation. Clinical manifestations including pain (n =12), a sensation of a snag (n =10), or blockage (n =8) had developed over a mean 15 months (2-24 months). Standard x-rays evidenced early signs of degenerative disease in four cases and acetabular dysplasia in four (5 degrees <VCE <18 degrees ), and were normal in four. Arthroscanography was performed in all cases and always evidenced a lesion of the anterior or anterosuperior part of the labrum, generally a fissuration (n =7). The surgical procedure performed on an orthopedic table with traction on the limb lasted 45 to 75 min for regularization of the degenerated labrum in three patients, resection of the languette in six, the anse de seau in two or the labral notch in one. A short hospitalization (24 to 48 hours) was sufficient with immediate weight bearing with two canes. One patient developed sciatic paresia which regressed in 72 hours with vulvar edema due to excessive peroperative traction. RESULTS: Besides the labral lesion, the exploration also identified an associated chondral lesion in seven cases (acetabulum in two, femoral head in three, both in two) which had been suspected in six cases from preoperative imaging (osteoarthrosis in four, dysplasia in two) and which affected the final outcome. Four of these patients (osteoarthritis in two and dysplasia in two) worsened clinically and radiographically to the point where a total hip arthroplasty was required in three. Among the three other patients, two had residual pain (osteoarthritis in one and initial x-ray normal in one) with no radiographic deterioration and only one (osteoarthrtis) was totally relieved without any radiographic deterioration at six years follow-up. Among the five patients with no chondral lesions, three (with normal x-rays initially) were pain free at four years follow-up while the two others (dysplasia) had residual pain at two years follow-up with no sign of osteoarthrtis on the latest x-rays. DISCUSSION: Lesions of the acetabular labrum are uncommon but can be treated arthroscopically. Resection of the labral lesion is immediately effective but does not prevent long-term degradation of the joint if there is an associated chondral lesion.
The characteristics of patients and the radiological condition of hip joints that required surgery because of residual dysplasia in the course of growth after treatment by the Frejka pillow have been presented. That treatment was employed in 4 per cent of the treated hips. The operations consisted in inspection of the joint, transiliac osteotomy after Dega with subtrochanteric osteotomy with detorsion of the femur, of the same type of operation without opening of the joint, performance of only transiliac osteotomy or only subtrochanteric osteotomy. Because late evaluation at over 10 years of life revealed 5 per cent of hips with poor rebuilding that should be treated surgically, it has been determined that the total number of cases requiring surgery after treatment by the Frejka pillow is 9 per cent.
Pyle type metaphyseal dysplasia is a rare autosomal recessive disease that is primarily affect metaphyses. Here we present a case with Pyle type metaphyseal dysplasia. The characteristic features of the case were metapyhseal broadening with undertubulation and Erlenmeyer flask sign at distal femoral and proximal tibial metaphyses. There were also platyspondyly with biconcave lens appearance of the vertebral bodies, congenital hip dislocation and normal cranium. Bone histopathology showed decreased number of osteoclasts. To the best of our knowledge, this is the first reported case of Pyle type metaphyseal dysplasia from Turkey.
Several complications following Pavlik harness splintage for congenital dislocated hips have been described. Two cases are reported where prolonged Pavlik splintage without concentric hip reduction caused posterior acetabular deficiency. Open reductions were required in both cases to correct deformity.
This is a retrospective review of nineteen innominate osteotomies with an average follow-up of 20, 6 years. These osteotomies were done mainly for treatment of late diagnosed congenital hip dislocation, or occasionally for persistent subluxation after orthopaedic treatment. The mean age at diagnosis was 2 years 2 months, at operation 3 years 5 months. We performed eight combined open reduction and pelvic osteotomies, eight associated pelvic and femoral varisation derotation osteotomies and only 3 isolated pelvic osteotomies. At follow-up the Charnley hip's score is 5.7 for pain; 5.4 for gait and performance, 5.6 for mobility. We found 15 hips without any significant pain and only 4 hips with mechanical pain. The Xray evaluation shows an average CE angle at 28.5 degrees, AC angle at 16 degrees and anterior coverage on "faux profil de Lequesne" at 40 degrees; 4 hips show arthritic changes, 4 others had important deformation of the head of the femur, but without diminution of the height of articular space. 6 hips (1/3) in 4 patients must be reoperated in adolescence because insufficiency of coverage of the head of the femur: 3 because technical errors and 3 because osteonecrosis with progressive cervicocephalic valgus. This historical serie with a very important follow-up, demonstrate that between 1/3 and 1/2 of cases have some kind of problems mainly radiological. The quality of results depends on the respect of the conditions and technique described by Salter, early diagnosis and absence of osteonecrosis eventually caused by prealable orthopaedic treatment.
Fifty-one patients known to have developed avascular necrosis during treatment for congenital hip dislocations were studied. Thirty-nine patients were followed for a mean of 23 years, 7 months. They were classified as to the severity of involvement, the subsequent treatment provided, and their final result. The greater the involvement, the worse the outcome. Residual subluxation of hips resulted in a poor prognosis. Intervention with open reduction did not result in success. Varus femoral osteotomies and acetabuloplasties met with limited success. Total hip replacements have not resulted in long-term success.
A method for the orthopedic evaluation of a child during the neonatal period of life has been discussed. Emphasis has been placed on conditions affecting the lower extremities such as spinal anomalies, congenitally dislocated hip, and congenital foot disorders. Early detection and medical intervention can play an important role in lower extremity function.
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Accurate radiographic demonstration of pelvic anatomical landmarks is predicated on proper positioning of the patient. Interpretation of acetabular abnormality especially may be difficult when to the artifact created by pelvic asymmetrical positioning there is added true femoral head displacement. A radiograph of hip joint abnormalities in a child with congenital hip dislocation where positional distortion was present served to illustrate the problem. To clarify the direction and magnitude of acetabluar alterations with specific pelvic positions, radiographs and photographs were taken of anatomic models outlined by suitably placed lead markers. Clues to inappropriate pelvic positioning are loss of symmetry in the widths of the iliac alae, sizes of the obturator foramina, and positions of the "tear drop" figures.
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Twenty-nine Chiari osteotomies (eleven in children and eighteen in adolescents and adults) were critically reviewed after a minimum follow-up of two years and an average follow-up of 4.6 years. In four patients with complete dislocation and seven with moderate or severe subluxation, operations performed between the ages of four and fifteen years yielded five excellent or good results, three fair results, and three poor results. In the eighteen adolescent and adult patients, all of whom had pain, there were eleven good, two fair, and five poor results, the poor results being due to technical errors for the most part. The identified technical pitfalls were too low an osteotomy and too much displacement of the osteotomized fragments.
Chiari osteotomy as the therapeutic approach in congenital hip dislocation has a special value in the adolescent patient with acetabular dysplasia and femoral head subluxation. The advantage is in the preservation of as much as possible of the modeling relationship of femoral head and acetabulum involved in hip joint motion while creating an effective lateral femoral head cover. Experience with Chiari osteotomy is described in a small group of adolescents (average age, 14 years) whose clinical problem is associated with limp, increasing fatigability and recurrent pain, with discussion of the complications contributing to significant morbidity, the technique of performance and the relative advantages and disadvantages of the procedure.
Home-based traction is an alternative treatment to conventional hospital-based traction for children with orthopedic conditions such as congenital dislocated hip and Legg-Perthes disease. The application of a proposed theoretical model is used to describe the process of the home-based traction innovation. Creativity and innovation occasions a reconceptualization of stresses. The reconceptualization of stress, plus the operational support of coordinated in-home services, can help families and nurses in the community and in the hospital develop, implement, and evaluate this kind of innovative care. In applying the home-based traction professionals empower and legitimize parents as resourceful co-providers of care. The legitimizing of the alternative in-home service affords parents a more optimistic appraisal of their situation as manageable. Parents are free to develop a coordinated response to their overall circumstance, including the treatment of their one child's illness. The evaluation of this home-based traction example found the alternative to be acceptable, safe, effective in accomplishing treatment goals, and less expensive than conventional hospital-based traction.