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Congenital hip dislocation and dysplasia in Southern Chinese.

In 1975 we carried out a survey in Hong Kong to locate Chinese children with congenital dislocation of the hip. Analysis of the available records between 1960 and 1975 gave an observed incidence which was at least 10 times less than found in Caucasians. The age and sex distribution, radiographic findings and the left-sided predominance were similar to Caucasians with congenital dislocation of the hip. However, unlike Caucasian children, the Chinese presented with dislocation and not dysplasia. The mothers of children with congenital dislocation of the hip were compared with a control group with normal children to assess their use of the "Hong Kong" position, in which the children are carried on the back of their mother with their hips in a position of wide abduction. Since only half of the children in either group were carried in this manner, other factors must be responsible for the low incidence of congenital dislocation of the hip in southern Chinese.

Adolescent↗

Congenital hip dislocation: an increasing and still uncontrolled disability?

A study of 178 cases of congenital dislocation of the hip in babies born between 1965 and 1978 in Southampton health district showed that the incidence had virtually doubled over this period. Established cases (persisting beyond the first birthday) had risen to around two cases per 1000 per live births. One-third of these were first diagnosed after the age of 1 year and one-fifth after 18 months. The findings are particularly disappointing as there were opportunities after the neonatal period for earlier diagnosis. Thus, neonatal screening appears to have failed to make a substantial impact on the morbidity of the disease, probably because of a combination of inherent difficulties in the neonatal screening test as well as failure in its proper application. Much greater vigilance is needed during the first year of life if congenital dislocation of the hip is to be detected and treated as early as possible. Perhaps this could be achieved if all health professionals were more aware of the problem and were encouraged to examine hips at every opportunity and health authorities periodically audited their results.

Child, Preschool↗

Hip-spine syndrome: total sagittal alignment of the spine and clinical symptoms in patients with bilateral congenital hip dislocation.

STUDY DESIGN: The influence of the pathologic state of the hip joint on the total sagittal alignment of the spine was investigated in patients with congenital hip dislocation retrospectively OBJECTIVE: The purpose of this study was to analyze the total sagittal alignment of the spine and the clinical symptoms in patients with bilateral congenital hip dislocation. SUMMARY OF BACKGROUND OF DATA: Abnormality in the hip joint causes abnormal curvature of the sagittal alignment of the spine and induces lumbago or lower leg pain. However, there have been no reports on the influence of bilateral congenital hip dislocation on the sagittal alignment of the spine. MATERIALS AND METHODS: A total of 9 patients (8 females and 1 male) were analyzed. Their average age was 57 years (range, 46-68 years). We measured the thoracic kyphosis (T1-T12), the lumbar lordosis (L1-S), the sacral inclination (SI), the femoral flexion angle (FFA), pelvic angulation (PA), and the distances from the pelvic hip axis (HA) to the C7 plumb line and from the promontorium to the C7 plumb line. To evaluate clinical symptoms, we used the Japanese Orthopedic Association (JOA) score of low back pain (full score is 29 points) and Visual Analog Scale (VAS) for lower back pain and lower leg pain, and the possible time of walking without rest. RESULTS: The average thoracic kyphosis, lumbar lordosis, SI, and PA were 42 degrees , -78 degrees , 68 degrees , and 27 degrees , respectively. The FFA averaged 10 degrees , leading to a duck-like posture. The distances from HA and, promontorium to the C7 plumb line averaged -2 cm and 4 cm, respectively. A posterior shift of the gravity line with respects to the hips was compensated for by lumbar hyperlordosis, which led to a posterior shift of the center of the spine. Regarding the clinical symptoms, the JOA score averaged 20 points and the VAS for lower back pain (lumbago) and lower leg pain averaged 6.4 and 3.1, respectively. The average possible walking time without rest was 20 minutes. CONCLUSION: The total sagittal alignment of the spine in patients with bilateral hip dislocation was compensated for by anterior angulation of the pelvis and by lumbar hyperlordosis. The main clinical symptoms were lower back pain, and not lower leg pain.

Aged↗

Treatment of congenital hip dislocation by muscle release, skeletal traction and closed reduction in older children.

A method of treatment of congenital hip dislocation by preliminary multiple muscle releases around the hip, followed by skeletal traction, is employed for closed reduction and immobilization with long leg cast. In 29 hips treated during the period from 1961 to 1972, the results justify the method for treatment of children 3 to 11 years of age with neglected high posterior congenital hip dislocations. The main prerequisite for the procedure is a fairly well-developed acetabulum.

Casts, Surgical↗

The results of neonatal treatment of congenital hip dislocation: a personal series.

Of 103 neonates with congenital dislocation of the hip in a consecutive personal series, 100 were treated with a standard divaricator splintage regimen; of these, the result is known in 97. In three babies with irreducible dislocation no treatment was attempted. In 90 babies the hips became normal. In one hip dislocation persisted; in three osteochondritis with femoral growth plate damage developed without obvious cause; and in two hip dysplasia responded to surgical correction of femoral anteversion. In one baby attempted treatment of irreducible hips produced a poor result. The practice of treating all hips found to be unstable at orthopaedic examination but not those previously suspected but later unconfirmed is defended.

Casts, Surgical↗