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Distal transfer of the greater trochanter.

After congenital dislocation of the hip, Perthes' disease and some other conditions, the femoral neck may be short and the greater trochanter in a relatively proximal position. Distal transfer of the greater trochanter is an effective and relatively simple operation to correct this deformity. We have reviewed 26 patients (27 hips) at a mean follow-up of eight years. Pain relief and improvement in gait were maintained in 74%, and the poor results were largely due to progression of osteoarthritis. We describe a 'gear-stick' sign of trochanteric impingement, which is useful in the pre-operative assessment of patients.

Adolescent↗

Observations in children with congenital dislocation of the hip.

In 111 children who were diagnosed and treated for CDH, certain variables concerning their vital statistics, the laxity of their joints and circumstances at birth were recorded. It was observed that breech presentation, birth rank one and female preponderance are common traits in children with CHD, who also become taller and heavier than control children. Anomalies found at birth or later were more common among these children, in particular inguinal hernia. Also, joint laxity was more common in these children. An increased incidence of CDH was found among siblings.

Abnormalities, Multiple↗

Late diagnosed congenital dislocation of the hip.

During the years 1975 to 1979, 82,574 children from five counties in southeast Norway were live-born, 197 of whom were treated for late detected CDH, for an incidence of 2.4 per 1,000 live births, i.e., 0.4 promille dislocation, 0.6 promille subluxation, and 1.4 promille dysplasia of the acetabulum without dislocation. All the hips had been found stable at birth. Eighty-six percent were girls, and the left hip was affected in 48 percent, the right hip in 31 perent, and both hips in 21 percent. Only 6.5 percent were delivered in the breech position. This and the stability found neonatally may indicate an etiologic difference between neonatally and late diagnosed CDH.

Breech Presentation↗

Why is congenital dislocation of the hip still missed? Analysis of 96,891 infants screened in Malmö 1956-1987.

During 1956 through 1987, 96,891 children have been screened for neonatal hip instability according to the tests of Ortolani and Barlow. In 1956 through 1972 only 4/58, 759 (0.07 permille) were missed, whereas during 1980 through 1987, 12/19, 398 (0.6 permille) were missed. This increase is not caused by any formal alteration of the screening programme. The screening has prevented a late diagnosis in all children born in breech presentation and in all boys except one. General factors such as female sex and joint laxity imply an increased risk for being missed in the screening, whereas mechanical factors such as breech presentation and the primogeniture effect likely facilitate an early diagnosis in the screening. The time between birth and the first examination is also of some importance.

Birth Weight↗