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PubMed1988

Breech position, delivery route and congenital hip dislocation.

The purpose of this study was to investigate whether the mode of delivery for fetuses in breech presentation in any way influenced the frequency of congenital hip dislocation. In 13,559 singleton births 583 fetuses were in breech position, and the cesarean section rate was 39.1%. Eighty-three infants were born with congenital hip dislocation, 11 of whom had been in breech position. Of these 11, cesarean section was required in 5 cases. There was no difference in frequency of congenital hip dislocation between fetuses in breech presentation delivered by cesarean section vs. by the vaginal route. The frequency of breech presentation in congenital hip dislocation was 13.3%. Including 7 external versions, the rate was 21.7%. Female to male ratio was 4:1. The frequency of congenital hip dislocations in infants born in vertex presentation was 5.5 per mille and for infants born in breech presentation it was 18.9 per mille.

Breech Presentation↗
PubMed2002

Open reduction of congenital hip dislocation by medial approach: case series.

AIM: To present the results of medial approach in open reduction of congenital hip dislocation, with the preservation of the medial femoral circumflex artery. METHODS: We operated on 48 nonreducible hip dislocations diagnosed in children aged 6-27 months. Twenty-two hips (17 patients) were available for clinical and radiographic follow-up. The median age of children at the time of operation was 15 months (range 7-29), and median duration of the follow-up was 4.5 years (range 3-14). The latest radiographic evaluation of the treatment outcome was based on Severins classification. RESULTS: There were three hips with the loss of concentric reduction. Osteochondritis developed in three, and coxa magna in seven hips. On final evaluation, 19 hips were rated as excellent or good (Severin I or II), and three hips as poor (Severin III or IV): one hip with evident ostechondritis lesions, and two hips with the loss of concentric reduction due to treatment discontinuation. CONCLUSION: By preserving circumflex medial artery and eliminating obstacles to reduction, vascularization of the femur head is ensured. The loss of concentric reduction is prevented by complete removal of all obstacles on the way of the femur head down to the bottom of acetabulum, by postoperative cast immobilization, and by walking with abduction orthosis for an appropriate period of time. Medial approach in surgical management of congenital hip dislocation in infants under 24 months of age is considered safe and efficient procedure.

Bone Nails↗
PubMed1982

Computed tomography in congenital hip dislocation. The role of acetabular anteversion.

Computed tomography usually can provide accurate documentation of the adequacy of a reduction in congenital dislocation of the hip. It should supplement other radiographic examinations when the status of a reduction is in question because the patient is wearing a plaster cast. The computed tomography scan provides a clear image of the reduction in the transverse plane, so that anterior or posterior subluxation of the femoral head can be easily detected. In addition it allows direct measurement of acetabular anteversion which previously had not been possible with non-invasive studies in the living patient. Radiation exposure is less than that for conventional tomography. We used computed tomography in five patients with congenital dislocation of the hip and our study provided new evidence concerning the role of acetabular anteversion in this condition. Acetabular anteversion was increased on the dislocated side in each patient, and returned to normal as treatment progressed.

Acetabulum↗
PubMed1976

Congenital hip dislocation: before and after walking age.

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.

Age Factors↗
PubMed1990

One-stage hip reconstruction with Dega's transiliacal osteotomy in the treatment of congenital hip dislocation in children.

Results of surgical treatment of the congenital dislocation of the hip in 40 children (2-5 years) are presented. The mean observation period was 8 years. 80% of very good and good results were obtained in the included material. One-stage hip reposition -reconstruction with Dega's transiliacal osteotomy, applied to children of 2-3 years, gives positive results, adding to further development of the hip joint.

Child, Preschool↗
PubMed1990

[Pavlik's harness in congenital hip dislocation before the first birthday].

Three hundred cases of congenital dislocation of the hip have been treated with the Pavlik harness since 1979. The reduction is obtained by progressive flexion of the thighs. The femoral head penetrates the acetabulum from bottom to top. Placing the harness and managing the treatment must be very carefully done. The explanation given to the family is essential to success. Complications are rare. Arthrography followed by reduction in traction should be considered in case of failure. The Pavlik harness is indicated under the age of 9 months.

Braces↗
PubMedDate not supplied

[[So-called congenital hip dislocation--development of incidence, diagnosis and therapy in the last 7 years].

PROBLEM: How has the Congenital Dislocation of the Hip (CDH) developed in the last 7 years concerning frequency, time of diagnosis and therapy? METHOD: Retrospective analysis of hospital reports, ultrasound- and X-ray images of children treated with CDH in the University Hospital. RESULTS: From 1. 1. 1991 to 31. 12. 1997 21 children with 28 dislocated hips were treated. The number of dislocated hips per anno is less than in a former study. In 17 children the diagnosis was found by ultrasound. The diagnosis was made within the first week of life in 8 children. In 9 dislocated hips, open reduction was necessary; in 7 of these 9 joints, diagnosis was made in the first days of life. CONCLUSIONS: Because of the distinct declination of CDH the "true" congenital dislocations, in which open reductions were often necessary, predominated.

Arthrography↗
PubMed1990

A new open reduction treatment for congenital hip dislocation: long-term follow-up of the extensive anterolateral approach.

Congenital hip dislocation, which is conservatively unmanageable, has usually been treated using open reduction. However, a long-term follow-up study of the results suggests that this procedure is unsatisfactory. Since 1973, Tanabe has used a new open reduction procedure that circumferentially dissects the joint capsule and produces sufficient concentric reduction of the femoral head in the acetabulum immediately after the surgery. Fifty-six children (65 hips) from the age of 1 to 3 years were treated by this procedure, and fifty-one of them were clinically and roentgenographically followed up from 6.3 to 12.4 years after the surgery. At the final follow-up session, all children had grown to be over 9 years of age, and no patient had clinically significant symptoms. According to Severin's classification, 33 hips were rated in Group I, and 14 hips in Group II. Another 10 hips were in Group III, and one hip was in Group IV. The incidence of avascular necrosis was 5.2 per cent. These data suggest that our procedure is more useful than the previous ones.

Child, Preschool↗
PubMed1990

[Screening for congenital hip dislocation in Belgium. Results of a survey in maternity wards. Proposals].

Congenital dislocation of the hip (CDH) is probably more frequent in our country than generally appreciated. In most European countries, the incidence of CDH varies from 6 to 20 per thousand living births. The screening for the condition is organized with the help of public services. Our purpose was to survey the maternity wards to estimate the extent of the occurrence in Belgium. A volunteer orthopedic surgeon met with the pediatrician and the obstetrician in every hospital with a maternity ward to complete a questionnaire. We present a detailed analysis of the results of the survey and propose a better system for screening.

Belgium↗
PubMed1990

[First-choice orthopedic treatment in congenital hip dislocations discovered after walking age].

The incidence of late discovery of congenital dislocation of the hip is getting lower, thanks to systematic screening. We have treated 14 children during the past 5 years. Clinical diagnosis was confirmed by radiography. Thirteen children were treated by slow reduction, and immobilization according to Somerville-Petit's method. Four surgical treatments were performed (1 Klisic operation by first intention, 3 Salter operations by second intention). Good clinical results have not always correlated with radiologic normalization. These results were evaluated by Séverin's classification: 9 excellent or good (I or II), 4 poor results (III). Although improvement is expected in the future, repeated clinical and radiological supervision permits evaluation of the indications for a subsequent operation at the most favorable time.

Age Factors↗
PubMed2005

One-stage treatment of congenital severely dislocated hips in older children through various acetabuloplasty techniques: 22 children followed for 1-5 years.

BACKGROUND: There is no consensus regarding the best treatment for children with late diagnosis of congenital hip dislocation. PATIENTS AND METHODS: This retrospective study involved 29 hips in 22 children (19 girls) with an age range of 3-14 years, who had been operated with various techniques for congenital hip dislocation between 1998 and 2002. 6 patients had right, 9 patients had left, and 7 patients had bilateral congenital hip dislocation. The mean length of follow-up was 3 (1-5) years. RESULTS: While the mean acetabular index was 53 degrees (35-65) preoperatively, at the last follow-up it was 30 degrees (15-50). 27 hips were type 4 and 2 hips were type 3 by Tönnis criteria. Satisfactory reduction (Severin Class I) had been achieved in 19 hips at the follow-up radiography, and they developed no osteonecrosis. The outcome was successful in children under 7 years of age, but problems encountered in those over 7 increased unless sufficient reduction had been achieved. INTERPRETATION: Age at treatment of late-diagnosed congenital hip dislocation appears to be important for outcome.

Acetabulum↗