[On the treatment of old traumatic dislocations of the hip and dislocation fractures in childhood].
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Pathologic dislocation of the hip in von Recklinghausen's disease: a report of two cases.
We report two cases of von Recklinghausen's disease in which hip dislocations occurred gradually without trauma. In one case, the right hip joint dislocated at the age of 8 years, and in another case, the left hip dislocated at 2 years and the right hip at 3 years. Each case was accompanied by bone changes around the affected hips, vertebral deformity, and spinal tumor. One case had hemihypertrophy of the involved lower extremity. Both structural changes around the hip joint and paralysis may have resulted in the hip dislocation.
Bone Neoplasms↗
Dislocation of the hips in children with bilateral spastic cerebral palsy, 1985-2000.
The aim of this study was to assess the rate of hip dislocation at different ages in children with bilateral spastic cerebral palsy attending special schools in southern Derbyshire, UK, between 1985 and 2000. The medical notes of 110 individuals (68 males, 42 females) were obtained. They were divided into four groups according to the Gross Motor Function Classification System (GMFCS). We determined whether or not their hips were dislocated at the ages of 5, 10, and 15 years, and the kind of surgery performed in each case. The percentage of individuals with one or both hips dislocated increased with age and with severity of disease. Of those in GMFCS Level II (n=18), none had dislocations; Level III (n=16), none had dislocations at ages 5 and 10, but 11% had by the age of 15; Level IV (n=35), 8% had dislocations by age 5, 19% by age 10, and 30% by age 15; Level V (n=41), 22% had dislocations by age 5, 48% by age 10, and 50% by age 15. Forty-two per cent of individuals with hip dislocation had not had previous preventive surgery. Twenty-one per cent of hips operated on still proceeded to dislocation. We conclude that there was a high rate of hip dislocation, especially in GMFCS groups Levels IV and V, and that this often occurred very early. Preventive surgery avoided dislocation in many children. However, orthopaedic referral was often not made before dislocation was discovered, or the referral was made too late for surgery on soft tissue to be successful. These results may be compared with those from current programmes of hip management, involving radiological surveillance and early use of conservative and surgical interventions.
Adolescent↗
Anterior perineal dislocation of the hip with fracture of the femoral head. A case report.
Traumatic anterior perineal hip dislocation with an associated fracture of the femoral head is a rare entity. A 26-year-old man injured in a motorcycle accident was treated by closed reduction of the dislocation within three hours after admission. However, several reports of patients with anterior hip dislocation with associated femoral head fractures were treated nonoperatively and had unfavorable results when treatment failed to achieve anatomical position of the fragments. Consequently, this patient was treated by open reduction and internal fixation of the fractured fragment. Follow-up examination three and one-half years after the operation showed painless functional range of hip motion with only minimal discomfort after prolonged exertion.
Adult↗
[Irreducible traumatic dislocation of the hip caused by labral and capsular entrapment with a buttonhole effect].
Irreducible hip dislocation following capsular and labral entrapment is a rare condition. We report a case of irreducible posterior traumatic pure hip dislocation where reduction was successfully achieved only with open surgery. An analysis of this case in the light of the published literature recalls the different etiologies of irreducible traumatic dislocation of the hip and the requirement for open surgery.
Acetabulum↗
Recent advances in the prevention, early diagnosis, and treatment of congenital dislocation of the hip in Japan.
Results of animal experiments and then of clinical study of newborn infants suggested that the main mechanical factor causing hip dislocation is prolonged tension on the hamstrings and iliopsoas and that each of these muscles has a synergistic effect in the production of hip dislocation during the perinatal period. It was, therefore, presumed that the high incidence of congenital dislocation of the hip (CDH) in Japan might be due mainly to the Japanese tradition of forcibly maintaining the legs of infants in an extended position with a "swathing diaper." The incidence of CDH in Japanese infants prior to 1965 was as high as 1.1%-3.5%. In an attempt to reduce the incidence of CDH, examination of newborns was performed on a national scale. However, early screening methods for hip abnormalities were not adequately reliable in Japan to allow identification of conditions that would later become CDH. In 1975 a national campaign to avoid prolonged extension of the hips and knees of infants during the early postnatal period was initiated. As a result, there has been a remarkable reduction in the incidence of CDH in infants, to less than 0.2%.
Animals↗
Superior dislocation of the hip. A report of 2 cases.
Anterior hip dislocation is relatively uncommon and constitutes only 12-18% of all hip dislocations. Of these the rarest type is the superior anterior dislocation; 2 patients are described, the mechanism of injury, management and complications discussed, and the literature reviewed.
Hip Dislocation↗
[Congenital anterior dislocation of the hip].
An apparently congenital antero-superior hip dislocation is identified during surgery. With reference to this case, three possible clinical courses for congenital hip dislocations are outlined: As a rule full recovery is most frequent. However, a posterior dislocation which is persistent tends to become postero-superior upon weight-bearing. Anterior dislocations as well as antero-superior subluxation appear to be rather common. Both pathology and the CAT scan attest to this fact. Extension, which is a true dislocating position for a retracted hip in adduction anc rotated externally, is probably responsible for such an evolution. Anterior dislocation and especially antero-superior subluxation are frequent findings which can be explained anatomically. The eventual complications of the antero-superior wall of the acetabulum resulting from these, will be the objective of most of the usual treatments for residual hip dysplasia.
Female↗
Recurrent traumatic dislocation of the hip: report of a case and review of the literature.
The case of a twenty-one-year-old female athlete with recurrent traumatic posterior hip dislocation is presented. A simple repair of an inferomedial capsular tear was performed. No bone block was used. The patient's recovery was uneventful. No avascular changes of the femoral head occurred and minimal formation of ectopic bone was observed. Eighteen months postoperatively, the hip functioned normally and the patient had returned to competitive alpine skiing. The literature on adult recurrent traumatic hip dislocation is reviewed.
Adult↗
MRI assessment of the posterior acetabular wall fracture in traumatic dislocation of the hip in children.
Traumatic hip dislocations associated with posterior wall fractures of the acetabulum in the pediatric population are in general a consequence of high-energy trauma. After expeditious reduction, instability mandates for further diagnosis and intervention. Plain radiographs or computerized tomography (CT) scans can misjudge the involvement of the posterior wall of the acetabulum due to the partially calcified nature of the pediatric bone. We present two cases of pediatric traumatic hip dislocation associated with posterior wall fractures of the acetabulum. In both cases, obvious postreduction instability was noted without conclusive findings of etiology on plain X-rays or CT scans. Magnetic resonance imaging (MRI) disclosed an extensive posterior wall traumatic involvement in both cases and helped to decide in favor of open reduction of the hip and internal fixation of the posterior wall fragment.
Acetabulum↗
Imaging of traumatic dislocation of the hip in childhood.
BACKGROUND: Traumatic hip dislocation in childhood is a rare consequence of violent trauma. After reduction, outcome is usually favourable although epiphyseal necrosis can occur. Reduction must be carried out as soon as possible and is achieved easily, although if the labrum is involved, surgery may be required to achieve complete reduction. OBJECTIVE: To analyze a retrospective series of traumatic hip dislocations in children, describing the therapeutic and imaging strategy. MATERIALS AND METHODS: A total of 42 patients were studied. Their mean age was 10 years 3 months. All relevant radiographic, CT, MRI and radionuclide bone scan examinations were reviewed. Special attention was paid to associated lesions. RESULTS: In 22 patients the dislocation was caused by low-energy trauma. Road traffic accidents accounted for 17 dislocations. An acetabular fracture was present in six patients and the femoral head was fractured in three. Reduction was easily achieved in 31 patients. In 11 patients the postreduction radiograph and CT showed joint space asymmetry secondary to labral entrapment. Only two patients developed epiphyseal necrosis. CONCLUSIONS: It has been difficult to define and evaluate accurate principles for a medical imaging strategy in this group of patients. Analysis of plain radiographs is essential before and after reduction of the joint, and it is important to perform postreduction CT in every patient whose joint space remains widened. A radionuclide bone scan should be performed between the second and third weeks after injury to assess epiphyseal vascularity. With the use of specific sequences, MRI may be an alternative modality to assess epiphyseal vitality.
Acetabulum↗
[A clinical and genetic study on the congenital dislocation of the hip].
Among 13,779 infants examined from 1974 to 1980 at Takashimadaira and Toride health centers, there were 45 patients with congenital hip dislocation, an incidence of 3.3 per 1,000 live births, that is, 0.08% and 0.53% respectively in male and female. The male to female ratio was 1: 7.4. Its incidence seems to be decreasing year by year with statistic significance, compared with the data previously reported. A family study was conducted based upon 117 patients with this disease diagnosed at the Tokyo Medical and Dental University from 1971 to 1980. Applying the recurrence rate of siblings and the incidence in the general population to the model proposed by Falconer, the heritability of liability to congenital hip dislocation in Japan is estimated to be 80 +/- 20% in males and 135 +/- 10% in females, which is beyond limitation of the heritability and much higher than Woolf's estimation (82% in male and 58% in female). This might be due to the insufficient size of the test population, but the genetic factors are presumed to play a more important role on the etiology of this abnormality.
Adult↗
[Ipsilateral knee and hip joint dislocation].
Knee and hip dislocations are often serious injuries with an uncertain outcome. Simultaneous ipsilateral dislocation of the knee and hip joints is very rare; consequently, there is an inadequate amount of literature on the subject. In this case report we present a 35-year-old male patient with this combination of both injuries and discuss it in comparison with the available literature. This case report shows, that a methodical and sequential treatment can lead to good results in spite of this complex combination of injuries.
Acetabulum↗
Managing chronic dislocated total hip arthroplasty.
Dislocation is the most common complication occurring after total hip arthroplasty. Thus, managing the patient with chronic dislocation will continue to be a challenging problem facing joint replacement surgeons. It is believed that several factors contribute to chronic dislocation, ie, surgical approach, inadequate restoration of soft-tissue tension, prosthetic design, and orientation of the prosthetic components. Methods of constraint, both internal and external, are valuable adjuncts available to the joint replacement surgeon that, with certain limitations, result in successful reduction of repeated dislocation and lead to initial stability of the hip joint.
Hip Dislocation↗
Dislocation after total hip arthroplasty.
Hip dislocation has long been one of the major complications after total hip arthroplasty (THA). From 1980 to 1994, we performed 2728 THAs (including primary and revision cases). There were 97 hips (3. 6%) with the complication of dislocation, 62 of which were followed up for at least 2 years (mean 5.3 years; range 2-12 years). Single dislocations occurred in 40% and recurrent dislocations in 60%. More than half of the dislocations (58%) occurred within 3 months after the index operation. The dislocation rate was not related to sex, age, previous revision surgery, or types of prosthesis, but was related to a smaller size of the femoral head. The rate of recurrent dislocation was not related to a history of previous surgery, but was related to a smaller femoral head, late onset of dislocation (> 3 months), soft-tissue imbalance, and cup malposition in both anteversion and inclination. If the size of the femoral head was 26 mm or smaller, a posterior approach was not recommended. Closed reduction followed by 1-2 weeks of skin traction was the treatment of choice. The success rate for the first attempt at closed reduction for the treatment of dislocation was 41%; the success rate decreased gradually with the number of attempts. For the recurrent dislocation group, bracing for 4-6 weeks with training was recommended for the postural type and bracing for 3 months with muscle training for the soft-tissue imbalance type. Only 15% of the dislocated hips needed re-operation, and most of the patients resolved the problem after being informed and undergoing muscle training.
Age Distribution↗
Total hip arthroplasty in high congenital dislocation. 21 hips with a minimum five-year follow-up.
Total arthroplasty was performed on 21 congenitally dislocated hips in 18 women. In all cases the femoral head was dislocated cranially at least one-fifth of the height of the pelvis. The components were both cemented, the acetabulum being replaced to its original position. The acetabular roof was reconstructed by bone graft in 13 hips, and trochanteric osteotomy was done in 18 hips. The patients were assessed at a median follow-up time of 7.5 years when their median age was 54 years. Nine patients had been revised or required revision. At follow-up the average functional score (according to Charnley) was 6 for pain, 4 for walking ability and 5 for range of motion. The Harris hip score was 82. The patients' subjective evaluation of their satisfaction with the late results on a visual analogue scale was 93, range 23 to 100. The high loosening rate in such patients demands regular follow-up and preparedness for revision surgery.
Acetabulum↗
The role of hip location and dislocation in the functional status of the myelodysplastic patient. A review of 100 patients.
One hundred patients 10 years of age or older with myelodysplasia were evaluated to compare located versus dislocated hips with regard to neurologic level, ambulation, hip pain, skin condition, and spinal deformity. Operated and nonoperated individuals were compared. Analysis was carried out to determine what the overall long-time function was in located, dislocated, and "relocated" individuals. Of the 100 patients, 72 presented at follow up with bilateral located hips, 18 with unilateral hip dislocations, and 10 with bilateral dislocations. Twenty patients functioned at T12 levels or above, 30 patients had preservation of anterior thigh musculature, and 25 patients had posterior leg or hip abductor power. Thirteen patients (15 hips) were found to have some degree of pain, 1 patient with bilateral dislocation, 5 with unilateral dislocation, and 7 with bilaterally located hips. Ambulatory function was not affected in any neurologic group by location versus dislocation of the hips. Skin ulceration problems were not increased in patients with hip dislocation. Major spinal deformity in most groups correlated highly with neurologic levels, but not with location versus dislocation of the hips. In one group, an increase in lumbar lordosis was present in unilateral hip dislocations. This study suggests that adolescents and young adults with myelodysplasia have different functional levels related to the neurologic level which are not related to whether the hips are located or dislocated.
Adolescent↗
Dislocation of hip in myelomeningocele. The McKay hip stabilization.
We reviewed the clinical and radiographic results of varus osteotomy of the proximal aspect of the femur and transfer of the adductor and external oblique muscles (the McKay procedure) in thirty-four children (sixty-six hips) who had an unstable hip secondary to a myelomeningocele at the middle or caudad lumbar level. the average age at the time of the operation was twenty months (range, seven to forty-two months). The average duration of follow-up was 10.9 years (range, 0.7 to 20.0 years). An open reduction was performed in ten hips. None of the children had had any previous operative treatment. The index operation helped to maintain the stability of thirty-seven of the fifty-one hips twenty-six children who remained neurologically stable: seventeen of nineteen hips that were at risk, two of three hips with acetabular dysplasia, fifteen of sixteen subluxated hips, one of three dislocated hips that had been previously reduced with a Pavlik harness, one of two dislocatable hips, and one of seven previously untreated dislocated hips. The index operation was not successful for one dislocated hip that had been treated with closed reduction and application of a spica cast. The operation was a success for eight of the fifteen hips in eight children who had a progressive loss of neurological function: three of five hips that were at risk, one hip with acetabular dysplasia, two of four subluxated hips, one of two that had been previously reduced with a Pavlik harness, and one dislocatable hip. Two dislocated hips redislocated. Initially the index operation was performed on all children who had a myelomeningocele at the third or fourth lumbar level. Recent data have shown that the hips in these children are not all at risk, and we now perform the operation only if there is documented instability of the hip.
Child, Preschool↗