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PubMed1983

The opposite hip in congenital dislocation of the hip.

A retrospective study of the development of the hip opposite a congenitally dislocated hip was carried out to identify at an early age those hips which would develop abnormally. Recognised radiological measurements were used showing the development of the joints with age. The development was compared with that of a control group of normal hips. Single measurements were shown to be unreliable in predicting the development of the hip. A simple hip ratio is proposed which predicts, at an early age and with a high degree of accuracy, the developmental outcome.

Adolescent↗
PubMed2002

Periacetabular osteotomy for stabilization of recurrent post-traumatic dislocation of the hip.

This article reports on the case of a twenty-eight-year-old woman who developed recurrent hip dislocation after open reduction and internal fixation of a posterior wall hip fracture-dislocation with an associated femoral head fracture. Because of the posterior wall deficiency, a modified periacetabular osteotomy was performed to stabilize the hip. At the two-year follow-up, there was no evidence of osteonecrosis in the remaining femoral head and the joint space was maintained. There has been no recurrence of dislocation. This procedure may be indicated in a patient with an unreconstructable posterior wall deficiency and persistent instability after a traumatic hip dislocation.

Acetabulum↗
PubMed2003

[Open reduction after failure of conservative treatment for congenital dislocation of the hip initiated before the age of six months].

PURPOSE OF THE STUDY: The aim of this study was to present the indications, technique and results of open reduction for congenital hip dislocation performed after failure of conservative treatment. MATERIAL AND METHODS: Criteria of inclusion in the series were: congenital dislocation of the hip treated conservatively before the age of six months requiring open reduction for failure of initial treatment between 1978 and 1998. During this period, 3000 hips sustained conservative treatment. The series counted 33 hips in 29 children. Mean number of different conservative methods used for one hip was 2.6. One-third of the hips had had previous surgery. Avascular necrosis was noticed in 17 cases (51.5%). Mean age at open reduction was 2 years. Pelvic (61%) and/or femoral (79%) osteotomies were combined with open reduction. RESULTS: Mean follow-up was 9.5 years. Among the complications, minor avascular necrosis was noticed in five hips without preoperative lesions. Hip joint congruency was excellent or good in 80.7% of the cases. There were no recurrent dislocations. Ten hips (32.3%) were free of avascular necrosis but 4 presented severe avascular necrosis (13%). DISCUSSION: Indications for open reduction are exceptional, attesting to the efficacy of conservative treatment. This salvage procedure achieves good results in the hands of experienced surgeons. The quality of the reduction depends not only on the intra- and extra-articular excision, but also on the stability achieved with peri-articular osteotomies. The main factor of prognosis is avascular necrosis induced by previous treatment.

Age Factors↗
PubMed1979

Open reduction for congenital dislocation of the hip using the Ferguson procedure. A review of twenty-six cases.

Twenty-three patients with twenty-six congenital hip dislocations treated by the Ferguson procedure were reviewed. The study was undertaken to determine if this method of treatment has any effect on the incidence of avascular necrosis of the femoral head and if there are preoperative factors that can assist in predicting the success of treatment. Clinical and roentgenographic criteria were utilized and only dislocations of the hip unassociated with other disorders were included. Avascular necrosis did not occur in these patients during the period studied. It was also found that patients who were more than twelve months old at the time of operation and had a acetabular index of 40 degrees or more had a high incidence of redislocation.

Casts, Surgical↗
PubMedDate not supplied

A treatment plan for the dislocated total hip arthroplasty.

A dislocated total hip arthroplasty must be evaluated for malposition of the component parts, infection, and an accumulation of fluid from an infection or inflammatory reaction. The treatment is directed toward correction of one or more of the above three abnormalities.

Adult↗
PubMed2001

Traumatic unilateral avulsion of the anterior superior and inferior iliac spines with anterior dislocation of the hip: a case report.

A sixteen-year-old boy involved in a high-speed motor vehicle accident sustained an anterior hip dislocation and avulsion of the anterior ilium extending from the anterior superior iliac spine to the anterior inferior iliac spine. The hip was emergently reduced, and further imaging was obtained to evaluate the bony injury. Computed tomography confirmed the presence of a large displaced bony fragment representing avulsion of the anterior superior and inferior iliac spines and a smaller fragment from the reflected head of the rectus femoris. The patient underwent open reduction and internal fixation of the ilium two days after the initial injury. Postoperatively, he was allowed to bear weight as tolerated with crutches but to avoid active hip flexion. He went on to an uneventful recovery, and at last report (approximately six months after injury), he had returned to full activity. An extensive review of the literature failed to show a similar injury of ipsilateral avulsion of the anterior superior and inferior iliac spines and reflected head of the rectus femoris.

Accidents, Traffic↗
PubMed1980

Recurrent traumatic dislocation of the hip in childhood.

An unusual case of recurrent traumatic hip dislocation in a 7-year-old girl is reported. She was conservatively treated and in an 8-year followup period no further recurrences had occurred and the hip was normal. Favoring factors and anatomic basis are discussed considering this case and those previously reported. Arthrography seems essential in its management. We feel that surgery is to be employed only if evagination through soft-tissue defects is demonstrated.

Accidents↗
PubMed1990

Anterior dislocation of the hip associated with fracture of the ipsilateral greater trochanter. A case report.

A 22-year-old male motorcyclist fell from a height and sustained an obturator hip dislocation with concomitant fracture of the ipsilateral greater trochanter. The immediate reduction of the dislocation associated with open reduction of the fracture of the greater trochanter showed excellent results at the short-term and long-term follow-up examinations. This extremely rare hip injury seems not to have been previously reported in the literature.

Adult↗
PubMed1992

Chronically unreduced traumatic anterior dislocation of the hip: a report of four cases.

Four cases of unreduced (2-11 months postinjury) anterior hip dislocation are reported. One public dislocation 2 months postinjury was treated by open reduction with a fair result. A unique case of iliac dislocation 11 months postinjury, overlooked due to an associated femoral shaft fracture, was treated by valgus/derotation osteotomy. Two obturator dislocations 7.5 and 9.5 months postinjury were treated by a subcapital osteotomy and displacement of the femoral neck into the acetabulum (modified excision arthroplasty). Both of these patients had fairly stable, painless, and mobile hips at 2.1 and 2.8 years follow-up. By our method, subsequent total hip arthroplasty remains a viable option, in contrast to the previously described method of trochanteric osteotomy, whereby the proximal femoral anatomy is distorted.

Adult↗
PubMed1990

Recurrent posttraumatic dislocation of the hip. A report of two cases and review of the literature.

Posttraumatic recurrent posterior hip dislocations were observed in two adult patients. In neither case was there evidence of acetabular dysplasia, paralysis, or infection. In both cases the only significant abnormality discovered was a marked posterior capsular redundancy. In the second case this was clearly shown by a computed tomography (CT) arthrogram. In both instances plication of the posterior capsule prevented further dislocations; however, the second patient developed massive heterotopic ossification around the involved joint and osteonecrosis of the femoral head. Investigation with CT arthrography of patients sustaining one or more dislocations in response to minimal trauma aids in evaluation of capsular abnormalities that may be surgically correctable.

Accidental Falls↗
PubMed1998

[Indentation fractures of the femoral head complicating the traumatic dislocation of the hip. Treatment by intertrochanteric osteotomy].

INTRODUCTION: Indentation fractures of the femoral head, are known to be rare with poor long-term prognosis. This study aimed to demonstrate that intertrochanteric osteotomy allowed improvement of late outcome after indentation fractures of the femoral head. PATIENTS AND METHODS: Between 1980 and 1984, four patients with a femoral head fracture after traumatic hip dislocation were treated by intertrochanteric osteotomy. The mean age at time of surgery was 24 years. The injury was a traffic accident in 2 out of 4 cases. All of four had indentation fractures of the left femoral head. All patients underwent immediate reduction of the dislocation. The intertrochanteric osteotomy, was delayed between 1 months to 3 years. Four Müller's osteotomies and one Sugioka's osteotomy were performed. One patient had 2 successive procedures. Mean pre-operative Merle d'Aubigne score was 13.5. In this retrospective study, results were assessed according to Merle d'Aubigne score and Epstein clinical and radiological method. RESULTS: Mean follow-up was 9 years (7 to 12). Three patients had a good result and one had two successive poor results in the same hip. Mean last follow-up Merle's score was 16.3 (15 to 18). The only poor result occurred because of late femoral head necrosis, in one hip with 2 successive osteotomies. DISCUSSION: As indentation fractures occurred in the upper part of the femoral head, the goal of the osteotomy was to displace the impacted articular surface out of the weight-bearing area. The prognosis of such lesions was usually poor, because in previously reported series, patients received no treatment. In our experience, intertrochanteric osteotomy could be proposed as an efficient therapy in femoral head indentation fractures.

Adolescent↗
PubMed1984

Congenital dislocation of the hip in children. Comparison of the effects of femoral shortening and of skeletal traction in treatment.

Preoperative skeletal traction as an aid in reduction of congenital hip dislocation in the older child has been associated with an unacceptably high incidence of avascular necrosis, redislocation, and poor results. In contrast, femoral shortening as an aid in reduction has yielded a high rate of very satisfactory results, and may be essential for obtaining a stable, physiological, non-compressive reduction. We have analyzed the complications and the radiographic and functional outcomes of treatment in thirty-nine hips. It was clearly demonstrated that femoral diaphyseal shortening was preferable to traction as an aid in the operative reduction of a congenitally dislocated hip in children who were more than three years old.

Child↗
PubMedDate not supplied

Teratologic dislocation of the hip.

We reviewed 27 teratologic hip dislocations in 17 patients. Four hips underwent closed reduction, 10 hips had medial adductor open reduction, 9 hips had iliofemoral open reduction, and 4 hips had iliofemoral open reduction and femoral shortening. Avascular necrosis occurred in 48%, redislocation in 19%, and subluxation in 22% of the hips. Results were best in those hips treated by anterior open reduction and femoral shortening and worst in those having closed reduction. Poor results correlated with multiple other involved joints, hypotonia, developmental delay, and poor head control.

Arthrogryposis↗
PubMed1988

Magnetic resonance imaging in congenital dislocation of the hip.

A study of structures which obstruct reduction of hip dislocation was performed on 15 hips by magnetic resonance imaging (MRI). Before treatment started, MRI studies were performed on 10 patients, six of whom were treated conservatively, after which further MRI studies helped to establish a concentric reduction. In the other four conservative treatment failed and they were operated on; in them the MRI studies were compared with arthrographic and surgical findings. In all but one of these 10 patients, MRI enabled us to differentiate between an everted and an inverted limbus. In five other patients with unsatisfactory development of the hip following closed reduction, MRI was compared with earlier arthrographic studies. MRI provided accurate anatomical information which would not have been obtained by arthrography. It clearly has great potential in assisting the surgeon to select the appropriate form of treatment.

Child, Preschool↗
PubMed1982

Congenital dislocation of the hip. Review at maturity of 147 hips treated by excision of the limbus and derotation osteotomy.

In 1957 Somerville and Scott presented their principles of management for the older child with congenital hip dislocation. They advocated preliminary traction followed, in those hips which remained dislocated, by excision of the limbus and subsequent derotation varus osteotomy of the femur. As alternative regimes are advocated it becomes increasingly important to subject each method to detailed long-term review. One hundred and forty-seven hips in 121 patients aged between 12 months and three years and treated by the standard Somerville and Scott regime have been reviewed. The age at review ranged from 16 to 31 years. The recall rate was 91 per cent. Each patient was seen regularly in a special clinic where detailed notes, radiographs and records were available. The results have been assessed clinically and radiographically by modifications of Severin's criteria to enable comparisons to be made with other published series. Attention has been focused on the good and the bad prognostic factors and on the long-term complications. The most worrying feature has been the premature onset of degenerative arthritis even in hips which seemed to have been satisfactorily reduced.

Child, Preschool↗
PubMed2002

Neonatal hip instability: results and experiences from ten years of screening with the anterior-dynamic ultrasound method.

AIM: To record the results and experiences from a 10-y screening period with the anterior-dynamic ultrasound method for detecting neonatal hip instability. METHODS: An ultrasonographic improvement of the Palmén/Barlow test was used. The screening programme included 22,047 newborns. Decisions about treatment were made solely on the ultrasound result. RESULTS: It was found that 175 infants (7.9/1000) had at least one unstable hip--dislocated or dislocatable. Dislocated hips were found in 1.1/1000. Dislocatable hips were found in 6.8/1000 but only 1.1/1000 needed treatment. The total frequency of treatment was 2.2/1000. All cases but one were diagnosed before discharge from the maternity ward. The rate of surgery was 0.1/1000 newborns. Girls were more affected than boys, by a ratio of 3:1. Among the affected hips 64.4% were a left hip. CONCLUSION: Neonatal hip instability is always present at birth and can be diagnosed immediately after birth. We have no indications that instability can appear at a later stage. The anterior-dynamic ultrasound screening programme is an efficient tool to diagnose neonatal hip instability and to decide when to begin treatment.

Female↗