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Congenital dislocation of the hip.

Neonatal hip dysplasia remains a difficult condition to diagnose and treat. Early periodic infant hip examination is the primary screening tool, but subtle hip instabilities can go undetected until fixed dislocations are discovered when the child begins to walk. Early nonoperative intervention in the neonatal period is usually effective using a Pavlik-type harness. For infants in whom this disorder is discovered after walking age, surgery is often needed to successfully reduce the hip. Radiographic evaluation of neonatal hip dysplasia is often difficult, but the evolving use of ultrasound, computed tomography, and magnetic resonance imaging is making this easier. The role of ultrasound as a primary screening device in the United States remains to be defined.

Hip Dislocation, Congenital↗

Neonatal diagnosis, treatment and related factors of congenital dislocation of the hip.

The unstable hip can be diagnosed in newborns with acceptable accuracy. The following factors are associated with the newborn unstable hip: female preponderance, breech presentations, cesarean section deliveries, first borns, left hip involvement, the Caucasian race, and increased birth weight. These findings suggest that the newborn unstable hip is determined prior to delivery, possibly within the last 4 weeks of intrauterine life. Diagnosed at birth, treatment in the average case is relatively short-term, effective, and without complication.

Abnormalities, Multiple↗

Capsular change following Chiari innominate osteotomy.

The case of a child treated at the age of 23 months for congenital dislocation of the hip by Chiari innominate osteotomy is presented. When additional surgery was required at the age of 4 years, exploration was made of the acetabulum which had been formed 2 years earlier by the Chiari procedure. Histologic evaluation revealed that capsular changes in the tissue interposed between the femoral head and the new acetabulum had produced well-vascularized, connective tissue with abundant collagen. The nature of the change in this tissue helps to explain why Chiari medial displacement innominate osteotomy may be successful.

Acetabulum↗

Comparison of the Frejka pillow and the von Rosen splint in treatment of congenital dislocation of the hip.

In southern Finland between 1966 through 1975, 920 newborns were treated with a Frejka pillow for dislocation of the hip. The treatment failed in 55 patients. The pillow was then rejected and replaced with the von Rosen splint. One hundred eighty patients were treated with the new method between 1978 and 1981. The treatment failed in one girl. At 3 years of age, one boy had slight features of avascular necrosis. Temporary skin irritation was found in 19% of patients. In two patients, the splint had to be replaced with a pillow because of skin problems. A treatment device which parents are allowed to take off between outpatient visits is not recommended.

Female↗

Avascular necrosis after open reduction for congenital dislocation of the hip: analysis of causative factors and natural history.

We analysed the causative factors and natural history of avascular necrosis (AVN) after open reduction of 87 dislocated hips. AVN was observed in 37% of the hips, yet open reduction did not appear to contribute to the development of AVN and its prevalence was similar in hips treated by open or closed reduction in our institution. Only 45% of hips with AVN had a good late result. More containment procedures were required if AVN had occurred. Premature physeal closure was one late manifestation of this complication, which occurred following apparent partial AVN changes.

Acetabulum↗