[New ceiling pedicle in the surgical treatment of pathological dislocations and hip dysplasias. Preliminary results].
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Adolescent↗
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[Detection of dislocation-prone hips in the maternity hospital. Apropos of statistics on 100 personal cases].
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France↗
Traumatic posterior dislocation of hip in children.
Traumatic posterior dislocation of the hip joint in children is an uncommon injury. It constitutes a true orthopedic emergency. It makes up over 80% of pediatric hip dislocations. In children, it can occur as a result of minimal trauma, which is attributed to a soft pliable acetabulum and ligamentous laxity. In skeletally mature adolescents, a greater force is required to dislocate the hip joint. Delay in reduction is associated with long-term complications such as avascular necrosis and degenerative arthritis. Avascular necrosis is related to the duration of dislocation. A poorer prognosis is associated with delay in reduction beyond 6 hours, advanced skeletal maturity, or multiple traumas. Prompt reduction minimizes complications. We report two cases of traumatic posterior dislocation of hip in children aged 3 and 14 years. Both were reduced within 6 hours of dislocation, and review at 6 months revealed normal examination and no evidence of any post-traumatic changes. Post-reduction treatment remains without a consensus. This review highlights the clinical presentation, management, and time-sensitive complications of the injury.
Adolescent↗
Overhead traction in the treatment of congenital dislocation of the hip.
Long-term results of traction treatment for congenital hip dislocation (CDH) performed between 1984 and 1990 are presented. The new traction scheme consists of 4 distinctive phases. It is based on gradually changed direction of traction--first, from the longitudinal direction to flexion and abduction against the hypomochilion. The traction is applied by means of non irritable adhesive tape using 1/4-1/5 of the child's body weight. The period of active traction is followed by retention period in Hanausek's biomechanical device. The success rate of the scheme, in terms of reduction, was 90 per cent. In 31 per cent the Salter innominate osteotomy was performed because of residual deformity. In 10 per cent of the cases open reduction was necessary.
Combined Modality Therapy↗
Earliest diagnosis of congenital dislocation of the hip by ultrasonography. Historical background and present state of Graf's method.
Since Graf in 1978 introduced sonography into examination of hip dysplasia and hip dislocation, we survey an experience of more than 38,000 infant hips. At the present sonography of the infant hip is a standard and superior to traditional diagnostic methods especially in infants under three months of age, if the following minimum requirements are fulfilled: 1. THEORETICAL AND PRACTICAL TRAINING OF THE METHOD: anatomic identification (landmarks, standard situation, standard plane), description and nomenclature of the sonographic hip types according to GRAF, measurement (bony roof angle "alpha", cartilage roof angle "beta"), dynamic examination, therapeutic consequences and follow-up, points of weakness and errors of measurement. 2. CERTAIN TECHNICAL STANDARDS OF THE ULTRASOUND INSTRUMENT: linear scanner, 5 MHZ (newborn: 7.5 MHZ). POSITIONING-DEVICE (patent: Fa Radl, A-8010 Graz-Austria) 3. SUFFICIENT DOCUMENTATION: projection similar to a ap-radiograph of the right hip, image scale never less than 1:1, black on white, two ultrasound scans per hip in the standard-plane. Suitable Systems: multiformat, dry copy, computer printout. Follow-up-studies have proved that in our region approximately five percent of hips under the age of three months require treatment, and that prognosis is better the earlier therapy is started. For this reason we recommend a sonographic screening of the newborn not later than six weeks of age.
Age Factors↗
[Not "only" a dislocation of the hip: functional late outcome femoral head fractures].
BACKGROUND: Traumatic hip dislocation combined with fracture of the femoral head is a rare condition for which little known in terms of long-term prognosis. The aim of the retrospective study presented here was to evaluate the clinical and radiological outcome of this specific injury. PATIENTS AND METHODS: In a 23 year period, 18 patients (17 male) with an average age of 25.6 (range 15-55 years) were treated. There were four type-I, three type-II, no type-III, and 11 type-IV fractures according to the Pipkin classification (1957). RESULTS: The average time to sufficient reduction was 136 min (60-420 min), two by open means. A total of 16 patients were operated for open reduction and internal fragment fixation, 13 through a dorsal approach. All patients filled out a standardized questionnaire, and clinical and radiological examinations were also carried out on average 12.6 years (range 59-247 months) after injury. Four scoring systems were used to classify the outcome: Thompson and Epstein (1951): very good = 1, good = 10, fair = 4, poor = 3; Merle D'Aubigne (1954): very good = 9, good = 5, fair = 0, poor = 4; Harris (1969): Pipkin I = 81 points, Pipkin II = 97 points, Pipkin IV = 73 points (mean); Brooker (1973): grade I = 5, grade II = 1, grade IV = 2. CONCLUSION: Quality of life was not reduced in most patients in the long term, however three of four patients suffering Pipkin type-IV fractures developed functional restrictions with poor results. We conclude that acute reduction of the dislocated joint and anatomical reconstruction of the femoral head instead of primary hip replacement may end in good to excellent results in type-I and type-II fractures. Due to the young age of these patients, joint reconstruction should always be the first choice even in type-IV fractures with a higher probability of poor prognosis.
Adolescent↗
Postreduction computed tomography in developmental dislocation of the hip: part I: analysis of measurement reliability.
Twenty computed tomographic (CT) scans of infants in spica casts after closed or open reduction for developmental hip dislocation (DDH) were analyzed for intra- and interrater reliability. Ten measurements of infant hip anatomy were assessed by three raters by using standard statistical analysis. All six measurements of acetabular anteversion and lateral or posterior displacement of the femoral metaphysis from the acetabulum or from a modified Shenton's line drawn from the pubic rami demonstrated both intra- and interrater reliability. All four measurements of acetabular structure could not be reliably measured either within or between observers. We also introduced a new measurement based on the principle of Shenton's line to aid in the assessment of femoral-head location after reduction in patients with DDH; this was reliably determined both within and among observers.
Female↗
Congenital dislocation of the hip associated with central core disease.
Central core disease is a congenital, non-progessive myopathy with proximal muscle weakness most prevalent about the pelvic girdle. Including out two patients there have been seven recorded cases of congenital hip dislocation associated with central core disease in children. Initial and recurrent contractures about the hip and knee should suggest the possibility of central core disease. However, the definitive diagnosis can only be made by muscle biopsy.
Adult↗
Familial primary acetabular dysplasia and dislocation of the hip.
Radiographic and clinical evaluation was done on 12 members of a kindred that included members with hip dislocation. Acetabular dysplasia was found in several members who did not have dislocation. This supports the concept that acetabular dysplasia is inherited and acts as a precursor to dislocation. Identification of infants with primary acetabular dysplasia may allow measures to prevent dislocation.
Acetabulum↗
The importance of sonography and radiography in diagnosis and treatment of congenital dislocation of the hip.
The advantages of the sonography of the hip joint in the diagnosis and treatment of hip dysplasia in 1992 "policlinic" children and 1100 newborns are discussed and compared with radiological methods. The treatment concept at the Orthopädische Universitätsklinik Bonn is described as well as its modification after introduction of the sonography in the hip dysplasia screening-examination. These results confirm the necessity of making an early diagnosis. The osteonecrosis of the hip as a complication of the treatment of hip dislocation is discussed.
Casts, Surgical↗
Prevention of congenital dislocation of the hip. The Swedish experience of neonatal treatment of hip joint instability.
The extensive work on early diagnosis and treatment of CDH (in the broad sense of this term) in Sweden has formed the basis of our present organization of prevention of hip dislocation. Practically all children are born in hospital, at present about 93,000 per year (1980). Routine examination of the hip joints has been included in the check-ups of newborns since the beginning of the 1950's. The centralization of obstetrics, especially during the last decade, has facilitated the organization of these examinations by paediatric consultants in all obstetric departments. All cases of hip joint instability are recorded, and during the last few years the frequency has been about 12 per thousand, probably with some over-diagnosis due to registration of uncertain cases. All definite cases of hip instability have been treated immediately at the orthopaedic departments. A study of a series of untreated newborns with transient instability has shown that the majority, but not all, will develop normal hip joints without treatment. This has been one reason for the recommendation to treat all unequivocal cases of hip instability. The present organization of examination and treatment is described. Detailed and practical instructions for the examination and treatment are given. Follow-ups of children treated for hip instability in the neonatal period are reported. It has been found that in practically all these patients anatomically normal hip joints are achieved by means of correct and carefully followed up treatment. The findings in 65 patients with neonatal hip instability in whom the treatment was unsuccessful or inadequate have underlined the importance of a strict treatment schedule, experienced doctors and detailed information to the parents. The effect of diagnosis and treatment of hip instability neonatally on the frequency of late-diagnosed cases of CDH was studied by recording all late-diagnosed cases at all orthopaedic departments. It was clear from the latter study that instability of the hip in newborns represents "preluxation" and that the treatment of this can prevent later dislocation. Dislocation of the hip joint in newborn infants is very unusual. Nowadays it is rare even after the neonatal period--in recent years only 12% of the late-diagnosed CDH cases between 1 and 6 months of age at diagnosis. However, the total number of late-diagnosed cases in the whole country has not decreased by more than 50% compared with the period prior to the introduction of hip examination of newborns.(ABSTRACT TRUNCATED AT 400 WORDS)
Child↗
Coxa magna after open reduction for developmental dislocation of the hip.
We studied coxa magna after open reduction of developmental hip dislocation, including the etiology, incidence, and influence on the long-term results and acetabular development. Forty-seven hips in 47 patients were radiographically examined for at least 10 years, and another 20 hips in 20 patients were examined arthrographically at an early stage after open reduction. At follow-up, the incidence of coxa magna, which was defined as a femoral head with a size > or = 20% greater than the opposite side, was 34.0%, and that seemed to be one of factors that worsened the long-term results. One of the most important causes of coxa magna is to overwiden the acetabular capacity by excising the limbus; another cause is the surgical invasion and synovitis of the hip joint after operation.
Child, Preschool↗
Comparison of inpatient and outpatient traction in developmental dislocation of the hip.
We studied 83 hips in 72 children being treated for developmental hip dislocation to assess the influence of home traction upon the incidence and severity of avascular necrosis (AVN). We compared two types of traction prior to closed or open reduction: inpatient Bryant's skin traction (40 hips), and outpatient (home) Bryant's skin traction (43 hips). No routine in-traction radiographs were taken in either group. After traction, a stable closed reduction was achieved in 55 hips (66%). Open reduction was performed on 28 hips (34%). The rate of severe AVN involving growth disturbance and resultant deformity (Bucholz types II, III, and IV) was low in both traction groups (inpatient, three out of 40, outpatient, one out of 43). These results demonstrate that an outpatient traction program without attention to radiographic hip station is as safe as identically instituted inpatient programs, as well as those that emphasize achievement of a traction reduction or a predetermined hip station.
Ambulatory Care↗
Unusual displacement of the femoral head in anterior traumatic dislocation of the hip. A case report.
An unusual case of anterior traumatic hip dislocation which occurred in a thirty-three-year-old man is described. The femur had a 90 degree anterior rotation while the femoral head was exactly at the same level as when normal. The best term suited for this type of dislocation is "intermediate" or "inguinal" because the femoral head was dislocated anteriorly but remained at the normal level.
Accidents, Traffic↗
Drain entrapment and titanium to ceramic head deposition: two unique complications following closed reduction of a dislocated total hip arthroplasty.
Postoperative dislocation remains one of the most frequent complications following total hip replacement. In this report, a case is presented that illustrates two potential concerns with postoperative dislocation and subsequent closed reduction. The first complication presented in this report is entrapment of a closed drainage system tube in the joint space following closed reduction. The second complication, transfer of metallic debris to a ceramic femoral head from contact with an acetabular shell during closed reduction, was documented by analysis of a femoral head using scanning electron microscopy and energy dispersive x-ray spectrometry. This report emphasizes the need for the surgeon to express caution when relocating a dislocated hip, particularly when a closed drainage system is used postoperatively.
Ceramics↗
Unreduced anterior dislocation of the hip in a child.
A case of unreduced anterior hip dislocation from trauma is reported, and the literature is reviewed. This is the fourth such case reported in a child.
Accidental Falls↗
A natural course of a dislocated healed tuberculous hip in a child. A case report.
Subluxation was once a common complication of the tuberculous hip, even when properly treated. A review of the English literature failed to disclose the corrective process of development of the hip joint following a debridement operation. A three-year-old boy having a proven tuberculous hip had his hip dislocated after joint debridement. In the ensuing ten years, the luxated head spontaneously reduced to nearly normal position. Transitory capsular laxity was believed to cause the dislocation in this case, while growth and development led to spontaneous reduction. A decade may elapse before relocation is complete.
Child, Preschool↗
Nontraumatic dislocation of the hip following screw/plate fixation for a femoral neck fracture.
An unusual case of nontraumatic hip dislocation following screw/plate fixation of a basicervical fracture of the neck of the femur, which is unassociated with sepsis, is reported.
Aged↗