Bilateral central fracture-dislocation of hips after myelography with meglumine iocarmate (Dimmer X).
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In 158 patients with myelomeningocele, the prevalence of hip dislocation at birth and subluxation or dislocation of unoperated on hips at 2 and 15 years of age were assessed. In neonates examined during the first 10 weeks of life, 10 percent of the hips were dislocated. In children with a thoracic or L1-2 neurologic level, the cumulative incidence of dislocated hips increased from 8 to 26 percent and subluxations from 33 to 45 percent. In children with L3 and L4 levels, one fourth of the hips had dislocations and nearly half subluxations. At L5 and the sacral motor level, dislocations did not occur, but one fifth of the hips had subluxations. Children with L3 or L4 neurologic levels had bilateral hip dislocation at an earlier age than those with higher levels of paralysis. There appears to be no risk of developing hip dislocation at neurologic levels below L4, and spasticity promotes hip dislocation above L3.
Thirty-two synovial chondromatoses of the hip have been treated surgically. Nine cases were discovered accidentally in arthrotic hips being treated by total arthroplasty. Eleven partial joint clearances were made, five by an anterior approach and six by a lateral approach without dislocation of the hip, with bad results due to persistence of pathological synovium in the depth of the acetabular fossa. Twelve complete joint clearances were made with subtotal synovectomy and removal of all loose bodies, especially from the acetabular fossa, by dislocating the hip. The results were better and the prevention of secondary arthrosis and stabilisation of the hip condition was rendered more certain. Dislocation of the hip, with suitable precautions, does not cause avascular necrosis of the femoral head. Surgical treatment is indicated at an early stage in the disease and may prevent osteoarthrosis in a young subject.
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A cohort of children presenting with clicking hips was studied in two districts. In one district any child with a clicking hip was treated as though the hip was dislocated, i.e. by splintage in abduction, but in the other district no treatment was offered. None of the 'treated' group later presented with a dislocated hip, whereas four children were found with dislocated hips among the 'untreated' group. A further four children who were not treated because their hips appeared to be normal on the second examination later presented with dislocated hips. It is suggested that the accuracy of diagnosis in all units might be improved if the examination of the newborn was carried out by a limited number of doctors to whom greater experience would accrue. Further improvements would be made if any hip which was found to click on examination was treated as an unstable hip and splinted in abduction.
We examined the pseudocapsule in ten patients with posterior dislocation after total hip arthroplasty (THA) using arthrography to investigate the relationship between dislocation and the state of the pseudocapsule. The pattern of contrast medium pooling demonstrated on tangential views was evaluated. In five patients with early dislocation arthrography showed leakage indicating lack of pseudocapsule whereas there was no leakage in five patients with late dislocation. Repeat arthrography revealed healing of the pseudocapsule could progress by 6-8 weeks after dislocation. These findings suggest that the difference in the pseudocapsule between those who dislocate early and late may explain different clinical outcomes in the two groups.
The author proposes a method of differential diagnosis of hip dislocations and hip joint dysplasia in infants aged 3 months. The alpha-angle of hip dislocation with relation to trochanteric space is determined on an anteroposterior radiogram of the hip joints; 64 degrees means hip dysplasia, 65-69 degrees and more mean dislocation. This method was tested in 75 children (150 joints) aged 3 months. A mean diagnostic accuracy was 90.1%.