[Critical study of a personal series of surgical reductions of congenital hip dislocations in children].
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Limitation of abduction of hips in the newborn. Is it a clinical sign or a phenocopy of congenital hip dislocation?
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.
Adult↗
Computerised tomography in non-treated congenital hip dislocation.
Computerised tomography, carried out in 5 non-treated cases of congenital dislocation of the hip, shows that the femoral head can move in a large anteroposterior cavity. When the hip is extended the common position of dislocation is lateral superior and slightly anterior to the acetabulum. When the hip is flexed (at a right angle), the femoral head is located posterior and slightly superior to the acetabulum. Dislocation reduction has always been possible. When the hip is flexed a large "click" takes place; whereas if the hip is extended, the "click" is less noticeable, or even absent.
Acetabulum↗
Reduction, capsuloplasty and pelvic osteotomy in surgical treatment of inveterate congenital hip dislocation.
A new surgical technique is described for the treatment of inveterate congenital dislocation of the hip in patients aged between 6 and 26 years, i.e., when it is too late for simple surgical reduction of the dislocation and far too early for a total hip replacement. The technique consists of reduction of the dislocated head, followed by capsuloplasty for covering the femoral head with a cap, and pelvic osteotomy with medial displacement of the inferior (acetabular) part of the pelvis. In the 16 patients (17 hips) treated thus far, the follow-up shows that good restoration of hip function has been achieved.
Adolescent↗
[Congenital hip dislocation; causes and sequelae of late diagnosis].
The causes of late diagnosis of congenital dislocation of the hip were examined retrospectively in a group of 49 children (56 hips affected). It appears that at neonatal examination as well as a further screening during the first year of life, the classical symptoms of this condition are not infrequently missed. The classical tests for the early diagnosis are described and the consequences of late diagnosis are studied. In spite of late detection, the final result of the treatment in most cases is quite favourable. However, this result can only be achieved by prolonged and intensive treatment, including hospitalization and surgery.
Child, Preschool↗
Unilateral congenital hip dislocation with contralateral avascular necrosis.
Seventy-six children with previoulsy undiagnosed unilateral congenital dislocation of the hip were examined after 2 years of age. Nine had radiologic signs of dislocation on one side and avascular necrosis of the contralateral femoral head. The incidence of necrosis on the contralateral side in older children with unilateral dislocation is much higher than among the normal population. The cause of these occurrences of aseptic necrosis is not known but could be associated with abnormal stress on an undislocated femoral head from dysfunction of a contralateral unstable dislocated femoral head.
Child↗
Congenital hip dislocations diagnosed after walking age: results of treatment.
The results of treatment of 64 congenital hip dislocations, diagnosed after the children were of walking age, were assessed anatomically, using two criteria--general femoral head shape and the C.E. angle of Wiberg. Results were also related to age at diagnosis and treatment methods. Radiologically 62% of the hips had normal or good results, and of these, 82% were obtained when the diagnosis was made and treatment started before the age of 36 months. In this series no correlation existed between anatomical result and treatment method.
Age Factors↗
[History and epidemiology of congenital hip dislocation in Brittany].
Brittany is a region of France with a high rate of congenital dislocations of the hip (CDH). This was shown by Le Damany, who, in 1912, did a systematic screening of newborns and compared the number of CDH in Paris and Rennes. In Paris, there was 0.8% and in Rennes 3.6% CDH. This frequency is not generalized in Brittany, however; and Setter, who did a large survey in Finistère in 1961 and 1962, showed that the epicenter was the canton of Pont l'Abbé, also called "pays Bigouden". However, this disease did not occur in this region of France in earlier times. In 1795, Cambry, according to the "Convention de la Jeune République", travelled in Finistère from village to village and did not notice any limping women. This was a very serious and precise study, and we may conclude that there was no CDH at that time; the disease occurred later in "pays Bigouden". From these basic facts, certain hypotheses are considered. From the point of view of genetics, a mutation apparently occurred in the 19th century, but there is no reliable genetic study. Autosomic heredity with incomplete penetrance, with variable penetrance according to sex may be considered: it includes a multifactorial origin of the disease involving genetics, environmental, biochemical and ethnic factors, including local customs and traditions.
Adult↗
A case-control study of congenital hip dislocation.
In this study we have investigated various epidemiological factors which may be related to congenital dislocation of the hip (CDH). Eighty-one cases born during the period 1st January 1988 to 31st August 1990, with four matched controls per case, were identified from consultants' records held at the Queen's Medical Centre and City Hospital, Nottingham. One hundred and twenty-four subjects who were referred to a new Hip Instability Clinic with suspected CDH, but not diagnosed or treated for CDH, were also included as a third group. Information about the mother's pregnancy, previous medical history and family history was collected from obstetric records kept at the two hospitals. Multigravidae and similarly multiparous women had a statistically significantly reduced risk of having a baby with CDH. The relative risks were 0.55 (95% confidence interval 0.33, 0.93) and 0.53 (95% confidence interval 0.31, 0.91) respectively. The method of delivery was also of importance. Babies born by Caesarean section or in breech position had an increased risk of CDH which was statistically significant. Using addition clinical information obtained from subjects attending the Hip Instability Clinic we also found that cases were more likely to have a family history of CDH than subjects who were screened for CDH but found to be normal.
Breech Presentation↗
Avascular necrosis in congenital hip dislocation. The significance of splintage.
Avascular necrosis is an iatrogenic complication of the treatment of congenital dislocation of the hip. In order to assess the incidence of this and other complications, we have reviewed a consecutive series of 211 children treated at some stage with the modified Denis Browne splint used in Adelaide. In 173 children treated with this splint alone for 238 subluxed or dislocated hips which were stable when reduced, six hips (2.5%) developed radiographic avascular necrosis, though there was progressive growth deformity in only one. There was a much higher incidence among cases treated for unstable reduction by tenotomy, plaster spica and then the splint, 20 of 33 hips (60.6%) showing radiographic signs, though only one led to progressive abnormality. Of seven patients treated by adductor tenotomy and the splint no case of avascular necrosis was encountered. In the whole series the incidence of significant long-term growth disturbance in children treated in this splint was 0.7%. The great majority of our cases of avascular necrosis were attributable to manipulation and plaster, not to the subsequent use of a splint.
Casts, Surgical↗
[Classification of deformities of the glenoid labrum in congenital hip dislocation].
The authors have developed their own classification of the deformities of labrum glenoidale in congenital hip dislocation. Open reposition was performed by the Ludloff procedure. The basic material for their work was the group of patients operated on at I. Orthopaedic Clinic of the Faculty of General Medicine of Charles University in Prague in the years 1970-1985. In the course of this period they operated on 78 hip joints in 70 children, out of which 8 operations were bilateral, the group comprised 17 boys and 53 girls, operation was performed on 30 right hip joints and 48 left ones. The age of children ranged from 5 to 23 months. The average age of children in time of operation was 9.3 months. On the basis of the cadaver material the authors have found out that glenoidale represents an extensive part of acetabulum. Labrum glenoidale is considerably more sizable in the dorsal parts of acetabulum so that the head seems to be completely enveloped by ligamentary limbus and the acetabulum seems to form at least half of the ball-shaped surface. In the dorsal and upper parts the acetabulum is from great part formed by a fibrous structure which is easily deformed. The pressure applied to the head dorsally can result in its dislocation just because the cartilaginous model of acetabulum is flat in its dorsal and proximal parts. This easily deformable structure is under certain conditions deformed by pressure of the head in such a way that in the first phase in the course of the onset of the dislocation it is always everted and in the second phase the evertion lither persists or the head shifts over the margin of the limbus and the limbus is then inverted by reposition force. The authors present in their work the classification of the limbus. Proceeding from operation findings they divide limbi into four groups according to differences in their shape: Type I: regularly annular (everted) limbus--it corresponds to a normal anatomic shape, it is not pronouncedly deformed and does not present an impediment to reduction. Type II: inverted gracilis limbus--it is exaggerated in comparison to the normal one, usually it is inverted in the acetabulum, it is never rigid but elastic. Together with the structure of capsule it can be an impediment to reduction. It can be relatively easily everted. Type III: inverted callous limbus--it is sizable, rigid, reducing by its position the capacity of the acetabulum. The reduction is usually difficult.(ABSTRACT TRUNCATED AT 400 WORDS)
Acetabulum↗
[The development of early diagnosis and treatment of congenital hip dislocation in Czechoslovakia].
The author gives an account of the early diagnosis and treatment of congenital dislocation of the hip joint in Czechoslovakia since 1918. He pays more detailed attention to the period before the Second World War and the period immediately after the war when aids now used on a world-wide scale were introduced into practice such as Hanausek's apparatus, Frejka's cushion and Pavlik's stirrups. At the same time screening of neonates in some areas was started. The author mentions also methods of preventive examinations of the entire population introduced in the fifties. He also pays attention to efforts to reduce the radiation load in X-ray screening of the population.
Czechoslovakia↗
[Several causes of complications of the surgical treatment of congenital hip dislocation].
The article is devoted to revealing of the causes of complications in children with congenital dislocation of the hip. 42 patients have undergone roentgenological, electrophysiological and neurological examinations; 32 of them had complications following surgical treatment of the dislocation of the hip. In the patients with complications disturbances in the structure of the lumbosacral section of the spine and neurological changes have been revealed. Reduced excitability of the motoneurons of the spinal cord has also been observed in these patients. In 10 children with satisfactory results the deviations in the structure of the lumbosacral section of the spine were insignificant, while gross neurological changes were not revealed. The authors have arrived at the conclusion that the main causes determining the results of surgical treatment are the initial state of the neuromuscular apparatus and dysplasia of the vertebral column structures. That is why in the patients with disturbances it is necessary to carry out adequate conservative therapy directed at improvement of the metabolism of the neuromuscular structures both before the operation and during the postoperative period, e.g. 2-4 times a year according to the expression of the neurological disturbances.
Adolescent↗
Monthly screening in the first six months of life for congenital hip dislocation.
The experience is reported of a five-year study of monthly assessment for congenital dislocation of the hip in suspected cases. The importance of persisting instability and of the "tightening adductor phenomenon" is stressed. The results indicate that monthly follow-up for six months greatly diminishes the incidence of late-diagnosed CDH.
Acetabulum↗
[Treatment of congenital hip dislocation using Pavlik's harness. Long term results].
PURPOSE OF THE STUDY: After many years using Pavlik harness for treatment of congenital hips dislocation, it is important to evaluate long-term results, failure causes and factors responsible for avascular necrosis. MATERIAL: One hundred and forty one children were treated by this mean (159 dislocated hips, 30 acetabular dysplasia). The follow up was 74 months (12-175). METHODS: In this study, the severity of the dislocation was evaluated by antero-posterior radiographs of the pelvis. The importance of proximal dislocation was measured by the distance from the top of the proximal femoral metaphysis to the Y line and the lateralization by the distance from the medial border of the proximal femoral metaphysis to the ischium. Results were appreciated using Severin classification modified by Kasser and Mose's circles. Several factors as age at the beginning of treatment, sex, previous treatment, passive abduction of the hip, amount of dislocation were statistically evaluated (chi 2 and P test). RESULTS: Of 159 dislocated hips, 10 (6.3 per cent) were not reduced by the harness. Temporary growth modifications and avascular necrosis were observed in 24 (16.1 per cent) of 149 reduced hips. We shall add to these, 3 avascular necrosis in 10 hips which were not reduced in the pavlik harness and 2 avascular necrosis which occurred in normal hips. This complication was not encountered in dysplasic hips without dislocation. Using Severin classification, there was 61 excellent, 33 good and 5 fair results in the group of 99 hips followed for more than 72 months. Of all growth anomalies and avascular necrosis, only half of them keep sequelae at the last follow-up. DISCUSSION: Some factors as age, sex, previous treatment have no incidence in the number of failures and avascular necrosis. On the contrary, passive abduction of the hip, severity of the dislocation were responsible for most of these complications. Pavlik harness must be used with circonspection. It can be used only where passive abduction is superior to 30 degrees and distance H superior to 4 mm. In other cases, it is preferable to use progressive traction. CONCLUSION: Pavlik harness is widely used for treatment of congenital hip dislocation. Reduction can be obtained as stabilisation and correction of acetabular dysplasia. The risk for avascular remains relatively high. The use of the harness needs a rigourous choice of indications.
Age Factors↗
Congenital hip dislocation. Long-range problems, residual signs, and symptoms after successful treatment.
In the treatment of congenital dislocation of the hip, reduction must be obtained and maintained to provide the proper stimulus for resumption of normal hip joint growth and development. Subluxation and avascular necrosis must be avoided, as degenerative joint disease is certain to occur. Acetabular dysplasia leads to degenerative joint disease with time, although no roentgenographic parameters are predictive. "Normal" hip joint anatomy may fail to develop, depending on the age of the patient at reduction and the growth potential of the acetabular cartilage. However, as normal anatomy as can be achieved should be restored at the age of maturity. This should provide the best possible mechanical environment to avoid exceeding the pressure tolerance level of the hip joint articular cartilage, thereby avoiding degenerative joint disease.
Hip Dislocation, Congenital↗
[5-year results of Salter's osteotomy in the treatment of congenital hip dislocation. Apropos of 30 cases].
Residual dysplasia and iatrogenic osteochondritis are two complications of treatment of congenital dislocation of the hip. Confidence is placed in the use of slow orthopedic reduction with a combined stabilizing Salter's osteotomy. This method was applied in 20 cases while in 10 patients a Salter's operation was performed for confirmed failure of orthopedic therapy. These were cases of severe dislocation, the mean age of the patients when starting treatment being 11 months. The mean age at the last follow-up examination was 5 years, when confirmation was obtained of the excellent clinical result, and particularly the radiographic outcome with normal cotyloid angles and good anterior cover. Pelvic osteotomy when mean age was 22 months produced as near as possible a normal hip before 6 years of age, without altering growth of the surperior extremity of the femur.
Age Factors↗
Skeletal traction vs. femoral shortening in treatment of older children with congenital hip dislocation.
A review of skeletal traction compared with femoral shortening in treatment of older patients with congenital dislocation of the hip clearly favors femoral shortening. During the period 1952-74, 30 hips in 22 patients (average age, 6 6/12 years) were treated with skeletal traction, and during 1971-77, 17 hips in 12 patients (average age, 6 8/12 years) were treated with femoral shortening. In those treated with skeletal traction, avascular necrosis developed in 57%; redislocation or subluxation in 30%; an X-ray rating (Severin) of poor in 43%; and the incidence of pin and skin complications was 27%. The average follow-up was 11 1/2 years. In the group treated with femoral shortening, there were no cases of avascular necrosis and none with a poor rating on X-ray. The average follow-up was three years and seven months and it was never less than one year. Complications included one refracture at the osteotomy site six weeks after surgery, one late resubluxation, and two redislocations (early in the series prior to routine use of Steinmann pin fixation). The redislocations were easily reduced. Acceptable leg length inequality was present in all unilateral cases except in one 12-year-old patient who required a contralateral epiphysiodesis. One patient with late subluxation had open reduction and acetabuloplasty.
Bone Nails↗