[Evaluation of the results of the treatment of congenital hip dislocations by acetabuloplasty].
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Acetabulum↗
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[Late results of surgical treatment of congenital hip dislocation by acetabuloplasty and corrective osteotomy of the proximal end of the femur].
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Acetabulum↗
[Analysis of the results of treatment of congenital hip dislocation with acetabuloplasty and detorsion osteotomy].
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Acetabulum↗
[Current role of the osteoplastic shelf in the treatment of sequelae of hip dislocation in adults].
This operation, first described by König at the end of the 19th century, continues to have some indications. This simple operation should be performed with a very precise technique: the new shelf is placed at the rim of the acetabulum on the capsule; the shelf should be solid and well-fitting, making any secondary displacement impossible, even when the patient is walking. The hip should be covered anteriorly and superiorly. The main indication is a dysplastic acetabulum, especially with a vertical roof. The best results are seen after operation on dysplastic hips without osteoarthritis; when osteoarthritis is present, the results are less good. The procedure is generally indicated only in patients younger than 45 years and it is relatively contraindicated in patients over 50 years old. It is very important to discuss the indication for this operation with the patient; it is a prophylactic measure performed on a hip with normal mobility and little pain.
Acetabulum↗
Newborn with an open posterior hip dislocation and sciatic nerve injury after intrauterine radiofrequency ablation of a sacrococcygeal teratoma.
Advanced prenatal ultrasonography techniques have allowed for better understanding of the natural history, treatment, and prognosis of sacrococcygeal teratomas. Several intrauterine surgical techniques to debulk the tumor when fetal and maternal life are in jeopardy have been described. Orthopaedic impairment, such as lower extremity weakness and swelling, also has been described in association with sacrococcygeal teratomas. The authors report on a newborn in whom a large soft tissue defect overlying the posterior hip region with direct exposure of the disarticulated hip joint existed at the time of birth, which resulted from intrauterine radiofrequency ablation of a sacrococcygeal teratoma. This unexpected complication has resulted in a loss of sciatic nerve function, malformation of the acetabulum and femoral head, and loss of the left ischium, coccyx, inferior sacrum, gluteal, adductor and piriformis muscles, and posterior hip capsule. At 16 months of age, the patient has a flaccid left lower extremity with a hypoplastic hip joint.
Catheter Ablation↗
[Clinical and ultrasonic diagnosis of congenital hip dislocation (dynamics of changes in early therapy)].
The authors present part of their prospective epidemiological study of congenital dysplasia of hip joints within which newborns were examined by ultrasonogram prior to the beginning of the therapy. Apart from the standard examination in the frontal plane after Graf they examined on principle also the ultrasonographic stability by the dynamic test after Schuler as well as by the application of the probe anteriorly with the simultaneous provocation according to Palmén. The authors have processed pathological ultrasonographic findings in 53 newborns (64 hip joints). The technique of the examination by ultrasound from the anterior approach is explained in detail. The comparison of both dynamic tests has shown that the examination from the anterior approach is considerably more sensitive than Schuler's dynamic test and also fully correlates with the clinical finding. It is a fact that the shift of the head in the flexion dorsally represents the most important component of the movement in unstable hip joint during provocation, it is far more noticeable than the lateralization of the head or the shift in the cranial direction. After achieving ultrasonographic stability the classical Graf method is sufficient for the registration of residual changes on the acetabular rim. The follow-up of patients until their complete healing has shown a surprisingly rapid remodellation of hip joints. The whole complex of clinically unstable hip joints has been divided into subgroups according to Graf classification. In type IIc or IId on the basis of ultrasonographic examination from the anterior approach the stable joints from the ultrasonographic viewpoint have been distinguished from unstable ones. The follow-up carried out in short intervals has shown that of longest duration is the remodellation of total dislocation and, on the contrary, of shortest duration is the healing of joints in the IIc or IId type. An absolute majority of affected hip joints have become normal until 3rd month of the age. The complex does not include two patients with teratological dislocation, the incidence of which has been determined in our study by the ratio of 2 cases in 35,550 of timely examined newborns. The role of the factor of spontaneous stabilization cannot be in this part of the study completely discounted. However, herewith we present part of an accomplished epidemiological study where the number of timely diagnosed patients including late diagnoses corresponds to the number of dislocations and subluxations determined within the conventional late diagnosis.
Female↗
[Prevention of congenital hip dislocation. To screen or not to screen?].
After a historical review and a description of the current situation in Western-Europe, the author analyzes certain "myths" and "preconceived notions" which, although generally accepted, are useless. The author reports on valuable clinical techniques in the prevention of CDH.
Age Factors↗
[Peri-acetabular pelvic osteotomy in the treatment of congenital hip dislocation in older children and adolescents].
The author describes a double osteotomy combining a pelvic (Salter) type of osteotomy and a periacetabular (Pemberton) type of osteotomy performed in one procedure by an anterior approach and aimed at a re-orientation of the acetabulum and a correction of any dysplasia. The technique is indicated in older children and adolescents when other procedures are not possible. However, this operation is not possible in cases where the circumference of the upper part of the acetabulum is smaller than that of the femoral head. It was applied in 30 hips with satisfactory results after a mean follow-up of one year.
Acetabulum↗
[Osteotomy of the iliac fossa in the treatment of a hip dislocation associated with a two-column acetabular fracture. Modification of the ilioinguinal approach to avoid an extended surgical approach].
Open reduction and internal fixation is the treatment of choice for displaced acetabular fractures. The surgical approach depends on the fracture type, concomitant injuries, and general condition of the patient. The ilioinguinal approach provides a good exposure to the medial wall and is associated with an acceptable degree of surgical trauma. Exposure of the joint surface, however, is difficult when using the ilioinguinal approach. We report a case of a polytraumatized 39-year-old patient who sustained a posterior hip displacement and a two-column acetabular fracture. An osteotomy of the iliac ala was performed via an ilioinguinal approach to fragments of the acetabular surface that were displaced distally. Thereby, reposition of a craniolateral fragment was achieved without the need to extend the surgical approach or to perform a second incision.
Acetabulum↗
[Results of treatment of congenital hip dislocation by extensionrepositioning and Hanausek-retention].
In the past 4 years all our patients below the age of three years, suffering from luxation or dysplasia of the hipjoint, were treated only conservatively. For repositioning we used a modified overhead-extension (Extensionsreposition). The "Hanausek-Apparat" was used only for retention. By this method all luxations could be reponed. Because of the low rate of re-dislocations and femur-head-nekroses, which decreased significantly from 23 per cent to 3.9 per cent, our method proved to be superior to manual repositioning under general anaesthesia, plaster-extension or early operation.
Age Factors↗
[Comparative analysis of osteotomy methods in open setting of congenital hip dislocation in children].
There is given an analysis of the treatment of 89 children (99 joints) with congenital femur dislocation, which were subjected to corrective osteotomy at the open setting by three different methods. There are shown the advantages of oblique osteotomy, proposed by the authors. There have been developed and substantiated the indications for application of oblique and transversal osteotomy of the femur.
Child, Preschool↗
Posterior acetabular spike: an obstacle to reduction in long-standing hip dislocations.
The posterior insertion of the transverse acetabular ligament can be transformed into a toothlike bony prominence narrowing the acetabulum in its distal part. This deformity can impede the placement of the femoral head deep in the acetabulum, making a complete reduction impossible. The toothlike spike can be detected by computed tomography or by intraoperative palpation, and can be corrected by pushing it back with a punch under palpatory control.
Acetabulum↗
Osteonecrosis of the femoral head after traumatic hip dislocation in the adult.
Osteonecrosis of the femoral head is most commonly classified according to the system of Ficat and Arlet, and the choice of treatment is based directly on the corresponding stage. Therefore it is important to accurately determine the stage of the disease because it has important bearings on the patient's clinical course. Patients with Stage I lesions (preradiologic stage of the disease) usually can be treated with pulsed electromagnetic fields with or without a core decompression, bone grafting and decompression, and rotational intertrochanteric osteotomy. These procedures are equally applicable for patients with Stage II lesions but frequently additional measures such as vascularized fibular grafting and intertrochanteric osteotomy may be necessary. Patients with Stages III and IV lesions also may be treated in a similar way, especially if one wishes to avoid total hip arthroplasty, especially in younger patients. The trapdoor procedure with autogenous cancellous bone and cortical bone grafting can be successful in Stage III osteonecrosis of the hip in patients with small- to medium-sized lesions. When core decompression is used to treat patients with Stage III lesions, an 89% satisfactory outcome can be expected providing that the lesion is small and central, and does not have head depression. Many times the number and variety of procedures tend to reflect the relatively poor results and the desire to avoid total hip arthroplasty. Arthrodesis continues to be an excellent and predictable treatment option and may be indicated when unilateral trauma is the etiology.
Adult↗
[Early quantitative detection of vascularity of the reduced femoral head of congenital hip dislocation by scintigraphy].
Vascularity of the femoral head of CDH was detected by 99mTc-MDP scintigraphy before and after reduction. The results showed that a decrease of second time-activity, intersection of minute time-activity and remarkable decrease of relative ratio and corrected relative ratio on the part of femoral head which closed to the acetabulum is the diagnosis criterion for the obstruction of blood supply of the reduced femoral head. We confirmed that the mechanical pressure was the factor which caused the obstruction of blood supply of the reduced femoral head.
Child, Preschool↗
[Congenital hip dislocation and the seasons].
This report deals with the data gathered for a year concerning the incidence of luxation coxae congenita at the Hospital de Gineco-Obstetricia (Gynecology-Obstetrics Hospital) of the Unidad Médica Oblatos (Oblatos Medical Unit) of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security) in the city of Guadalajara, Jalisco, México. The results show an inverse correlation between the temperature and the number of cases, both statistically significant, demonstrating seasonality for luxation coxae congenita.
Birth Weight↗
[Complete surgical correction of congenital hip dislocation (one-stage surgery)].
A 3-10 years follow-up and the evaluation of the 55 cases operated 1980 through 1988 on the Orthopaedic University Hospital in Pécs is presented. The age of the patients at operation was 4.5-10 years, in average 4 years. The operation consisted of four components: operative reduction, varus derotation femoral osteotomy, acetabular plasty and transposition of the iliopsoas muscle. In 53 cases excellent or good Roentgen anatomical and functional results were found. In one case after the operation complete femoral head necrosis has developed, in two cases a transient ischaemic state was observed that healed however without functional deficiency.
Arthroplasty↗
[Surgical treatment of congenital hip dislocation in adults].
In the article is summarized the experience of treatment of adult patients with congenital dislocation of the femur. In clinic there has been applied not widely practised access by means of inter--of supratrochanteric osteotomy. After that the proximal fragment of the femur is diverted outwardly and the capsule is opened on the medial side. In this way the blood supply of the head and neck of the femur is maximally spared. During 12 years there have been operated 67 patients aged 15-50 years. Dynamic observation of patients indicated absence of such grave complication as the aseptic necrosis of the head of the femur that is the principal confirmation of low-traumatic character of the operation.
Adolescent↗
Dissociation of modular total hip arthroplasty at the femoral head-neck interface after loosening of the acetabular shell following hip dislocation.
Modular component dissociation is a potential problem of current modular total hip arthroplasty (THA) systems. We describe a case of dissociation of the modular THA at the femoral head-neck interface after loosening of the acetabular shell during closed reduction for posterior dislocation of THA. The causes of this dissociation and acetabular shell loosening are discussed. Successful treatment was provided with surgical revision of the acetabular and the femoral head components. The present case serves as a graphic reminder that the acetabular shell overhanging the acetabular bone must be avoided when implanting modular THA components.
Biomechanical Phenomena↗