SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A total of 36 patients (42 hips) with frank congenital hip dislocation were studied. The initial clinical and x-ray signs were evaluated according to the age at which the patient was first seen and treatment started.
Explore the source record for details and available documents.
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.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Operative reductions of congenital hip dislocation are sometimes difficult when lateral incisions are used since the medial part of the acetabulum and the lower limbus are difficult to visualize. In the Ludloff technique this part of the acetabulum is seen excellent, but not the lateral part. High dislocations with inverted limbus are difficult to reduce and only with partial excision of the limbus. An inguinal incision beginning lateral at the spina ilica ventralis offers the best view and can be used for all different degrees of dislocation and age groups. The technique is described, the advantages and the rate of avascular necrosis compared with other incisions. Femoral osteotomies and acetabular or pelvic osteotomies should not be done at the same time because of a higher percantage of avascular necrosis. In high dislocaitons shortening osteotomies should not be done in the intertrochanteric region but deeper in the shaft to avoid additional disturbances of the vascular system of the proximal femur.
An experimental study of the extraosseous and intraosseous vascular and circulatory changes following traumatic hip dislocation in dogs and rabbits is reported. The observations were made by dissection, angiography and histology following posterior dislocation and reduction at varying intervals. Traumatic dislocation of the hip causes extraosseous circulatory disturbance in the hip resulting in intraosseous circulatory deficiency in the femoral head. The sites of the vascular lesions are the extraosseous branches of the femoral circumflex arteries and their extraosseous branches of the epiphyseal and metaphyseal arteries and the retinacular artery of the circulus vasculosus articularis. The types of the vascular damage are irreversible tear of the minority of vessels along the ruptured capsule and teres ligament, and the compression, traction and spasm of the majority of intact vessels which are reversible by early reduction. In prolonged dislocation the circulatory disturbance persists or worsens due to additional pathological changes such as posttraumatic inflammatory changes, fixed deformity in the dislocated position, thrombosis, fibrosis and occlusion of vessels which may eventually cause an ischemic necrosis of the femoral head. Early reduction within several hours after dislocation restores nearly normal regional anatomy and relieves vessels from compression, traction or spasm and restores extra and intraosseous circulation. It also prevents or minimizes thrombosis, fibrosis and occlusion of vessels and avascular necrosis of the femoral head.
A comparative study of 20 congenital dislocations of the hip with inverted limbus treated by closed reduction were compared with a group of 20 controls in which the limbus was non-obstructive as demonstrated by arthrography. In each group 3 hips developed signs of avascular necrosis. Seventeen of the 20 hips with inverted limbus and 11 of the 20 controls required subsequent femoral or acetabular procedures. Half of the hips in both groups at follow-up (mean 9 years) were dysplastic with a CE-angle of less than 20 degrees. Thus, the incidence of avascular necrosis and late clinical and radiographic results were comparable in both groups.
We determined the acetabular angles, center-edge angles, comprehensive quotients, and Shenton's lines from sequential roentgenograms of thirty-seven children with congenitally dislocated hips treated by closed non-manipulative reduction in early infancy. The values were compared with those obtained from roentgenograms of 164 normal children who ranged in age from three months to five years and of forty-three adolescents and adults. The hip recovering from congenital dislocation developed similarly to the normal hip but differed in that it showed a greater rate of decrease of the acetabular angle and an increase in the center-edge angle. Significant development after the age of five years still was manifested in the reduced hips.
Twenty-six cases of traumatic hip dislocation in children are presented. Although closed reduction was achieved in most instances, open procedures had to be employed in two cases of soft tissue interposition and in a patient with ipsilateral fracture of the femoral shaft. In 16 patients, with a follow-up averaging 14 years, the incidence of complications (avascular necrosis, coxa magna and arthrosis) was significant. Factors predisposing to abnormal results were delayed reduction and severe trauma. Neither the method of immobilization nor the interval without weight-bearing over 4 weeks were of influence. Principles of treatment are suggested.
We describe a development of a malignant hyperthermia (MH) syndrome, partially aborted by therapy, in a child with central core disease and congenital dislocating hips. Patients with central core disease appear to be more susceptible to MH; possibly those with elevated serum creatine phosphokinase levels, as in our patient, are especially susceptible. We review the clinical and pathologic aspects, possible pathogenesis, and treatment of the MH syndrome. An increased calcium level within the muscle fiber is suggested as the major cytodestructive factor, and that increase could be consequent to a plasmalemmal susceptibility to the provoking drugs hypothesized to be the basic defect in MH. Prevention of the full manifestations of MH is predicated on (1) a high index of suspicion in the search for history of anesthetic complications in the patient and his family, with or without evident neuromuscular disease, (2) recognition that there is a somewhat greater risk of MH developing in a patient who has certain "musculoskeletal" abnormalities or muscle weakness but that is not-except for central core disease-a classic clinicopathologically defined disease, (3) close monitoring of patients during anesthesia, and (4) if the syndrome develops, prompt therapeutic measures, including cessation of anesthesia.
A child victim of low speed violence was found to have a fractured femur and dislocation of the ipsilateral hip. This combination of injuries in a child is very rare. The dislocation was not initially recognized because of absence of suggestive history, symptoms, and signs. After recognition, open reduction of the hip dislocation was achieved through a posterior approach. One month later an osteotomy at the femur fracture allowed the leg to fall to neutral while maintaining the femoral head in the most desirable position.
Until recently the possibility of a connection between maternal thyroid disorders and congenital hip pathology in the newborn has not been given any attention. However, from this study it is evident that there is a close relationship between maternal thyroid disorders and limitation of abduction of the hips in the newborn. The histological findings are suggestive of a neonatal thyrotoxic myopathy or periodic paralysis which might give rise to an error in muscle balance around the hips. The high proportion of affected children without a family history of congenital hip dislocation suggests that genetic factors have in the past been overemphasized.
Explore the source record for details and available documents.
Residual morbidity from congenital dislocation of the hip is for the most part preventable. Prevention is possible, however, only by establishing the diagnosis early and undertaking treatment which leads to stable reduction and avoids complications. To attain these goals, hip examination whould be a routine part of all newborn care. When dislocation is found in a newborn and early treatment initiated, the anatomic abnormalities are minimal, the dislocation is rasily reduced, and the treatment is simple. When diagnosis and treatment are delayed, the soft-tissue and bony abnormalities become established and therapy becomes more complicated.