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PubMedDate not supplied

Why does pelvic deformity occur in experimental dislocation of the growing hip?

A three-dimensional pelvic deformity was observed when experimental dislocation of the hip was reproduced in Wistar rats using hormonal and biomechanical factors. Resection or surgical dislocation of the femoral head created its absence in the acetabular socket without pelvic deformity. Muscular contractures were observed in all animals. We conclude that progressive displacement of the femoral head could produce pelvic deformity and simultaneous alterations in the triradiate cartilage.

Animals↗

PubMed1987

Contractures in cerebral palsy.

Contractures in cerebral palsy (CP) are usually in flexion at the hips and knees, and in plantar flexion at the ankles. When correctly indicated, surgical release is appropriate. Occasionally, extension contractures of the hip and knee develop, and dorsiflexion contractures of the ankle may ensue. In CP, the management of each of these deformities may require different sets of operative procedures.

Adolescent↗

PubMedDate not supplied

Orthopaedic aspects of children with infectious (central nervous system) postnatal cerebral palsy.

Twenty-two children (15 girls, 7 boys) with postnatal infectious cerebral palsy were reviewed at an average age of 8 years. Orthopaedic deformities were noted in 82% of all children and involved the upper extremity (41%), spine (45%), hips (68%), knees (32%), and feet and ankles (55%). Both typical and atypical cerebral palsy deformities were noted, often severe. Surgical correction of deformities achieved 77% satisfactory results. Bony procedures did better than soft tissue procedures, especially around the hip.

Cerebral Palsy↗

PubMed1986

Iliopsoas recession through a medial approach.

A new method of performing iliopsoas recession in patients with cerebral palsy is described. The approach to the tendon is made by means of a medial incision. The method has been used on seven hips, and the results are comparable to those obtained by a formal anterior approach.

Cerebral Palsy↗

PubMed2004

Hip function in adults with severe cerebral palsy.

BACKGROUND: The reported prevalence of hip pain in patients with severe cerebral palsy has varied widely. It is unclear whether surgical treatment is indicated for progressive hip subluxation in immature patients with severe involvement. In the present study, we evaluated seventy-seven adults who were profoundly affected with cerebral palsy to determine if either spastic hip displacement (subluxation or dislocation) or osteoarthritis was associated with hip pain and/or diminished function. METHODS: Data regarding the medical history, level of function, pain, and use of analgesics were obtained from a review of medical records and from caregiver interviews. The range of motion of the hip, the degree of spasticity, the presence of pressure ulcers, and changes in vital signs as well as in the Face, Legs, Activity, Cry, and Consolability behavioral pain score were documented. Radiographs of the pelvis and spine were blindly evaluated for evidence of osteoarthritis and subluxation or dislocation. Statistical analysis was performed in order to identify associations between the medical history, the physical examination findings, and the radiographic measurements. RESULTS: The study group included seventy-seven adult subjects (thirty-eight men and thirty-nine women) with a mean age of forty years. Twenty-three (15%) of the 154 hips in these subjects were dislocated, eighteen (12%) were subluxated, and thirty-five (23%) had radiographic evidence of osteoarthritis. Twenty-eight (18%) of the 154 hips were definitely painful, and sixty-nine (45%) were definitely not painful. Increased hip pain and problems with perineal care were noted in patients with decreased hip abduction (<30 degrees ) (p = 0.01), windswept hip deformities (p = 0.02), and flexion contractures of >30 degrees (p = 0.07). Increased spasticity was associated with higher rates of osteoarthritis, dislocation, pain, and pressure ulcers. Spastic hip subluxation or dislocation was significantly associated with osteoarthritis (p = 0.0001), but not with hip pain. There was no association between radiographic evidence of osteoarthritis and hip pain. CONCLUSIONS: Neither hip displacement (i.e., subluxation or dislocation) nor osteoarthritis was found to be associated with hip pain or diminished function. Because the prevalence of hip pain is low and is not associated with hip displacement or osteoarthritis, we suggest that surgical treatment of the hip in severely affected patients be based on the presence of pain or contractures and not on radiographic signs of hip displacement or osteoarthritis. LEVEL OF EVIDENCE: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

Adult↗

PubMed2004

Operative treatment of bilateral hip dislocation in children with arthrogryposis multiplex congenita.

PURPOSE: Arthrogryposis multiplex congenita (AMC) is a rare syndrome with multiple joint contractures. It is commonly believed that bilaterally dislocated hips associated with joint contractures should not be reduced, because movement is satisfactory, while open reduction leads to poor results. This report presents our experience with surgical management of bilateral dislocation of hips in children with AMC. METHODS: During the period 1990 to 2000, we performed open reduction on 8 hips of 4 children with AMC. The mean age at surgery was 23 months (range, 5-48 months). Open reduction and capsular plication without any bony procedure were performed in 4 hips (2 patients). De-rotation and varus osteotomy of the femur was performed in 4 hips, and Salter osteotomy of the innominate bone in 2 hips. The average acetabular index was 44 degrees, and the mean centreedge angle was -41 degrees preoperatively. RESULTS: The average follow-up period was 4 years (range, 2-9 years). The average acetabular index and centre-edge angle were 19 and 18 degrees, respectively at the time of last follow-up. All children could walk without support. One child required re-opening for redislocation of hip joint. The clinical results were good in 6 hips and fair in 2 hips, according to Severin's and McKay's classifications. CONCLUSION: Our experience shows that open reduction for bilateral dislocation of hips in children with AMC is a suitable option with generally good results. Surgery performed at earlier age gives the best functional outcome.

Arthrogryposis↗

PubMed1985

Warfarin-induced iliopsoas hemorrhage with subsequent femoral nerve palsy.

We present the case of a 28-year-old man on chronic warfarin therapy who sustained a minor muscle tear and developed increasing pain and a flexure contracture of the right hip. Surgical exploration revealed an iliopsoas hematoma and femoral nerve entrapment, resulting in a femoral nerve palsy and partial loss of quadriceps functions. Anticoagulant-induced femoral nerve palsy represents the most common form of warfarin-induced peripheral neuropathy; it is characterized by severe pain in the inguinal region, varying degrees of motor and sensory impairment, and flexure contracture of the involved extremity.

Adult↗

PubMed1996

Anterior release for fixed flexion deformity of the hip in spina bifida.

We reviewed the results of anterior hip release for fixed flexion deformity in 57 hips in 38 children with spina bifida at an average follow-up of 8.9 years (2 to 22). The indication for this operation was a fixed flexion deformity of more then 30 degrees which interfered with function. In 43 hips there was a good outcome in that the fixed flexion deformity remained less than 30 degrees at follow-up. Four hips had a good initial result but deteriorated after an average of five years, and ten had a poor outcome with deformity of over 30 degrees. Six hips required a repeated anterior hip release and two of these were successful. The success of anterior hip release could not be related to the neurological level or the age at operation. Successful surgery correlated with the walking ability of the child at the latest follow-up.

Child↗

PubMed1985

Congenital contractural deformities of the fingers and arthropathy.

Four patients are described who presented with congenital finger contractures and arthropathy. There was synovial cell hyperplasia and giant cells but no inflammatory process. Radiographs showed flattening of the metacarpal and metatarsal heads and the proximal femoral ossification centres. In the oldest patient the process had subsided leaving slight contractures but severe impairment of hip mobility. In another the arthropathy was still prominent in the early teens. In a third, finger contractures had failed to respond to conservative or surgical measures.

Contracture↗

PubMed1991

Neonatal Marfan syndrome with congenital arachnodactyly, flexion contractures, and severe cardiac valve insufficiency.

We describe a male neonate with severe arachnodactyly, hypermobility of the fingers, flexion contractures of elbows, wrists, hips, and knees, micrognathia, crumpled ears, rockerbottom feet, loose redundant skin, and ocular abnormalities. Severe cardiac valve insufficiency and aortic dilatation resulted in cardiac failure and death 20 hours after birth. This case represents the severe end of the clinical spectrum of Marfan syndrome. As similar patients have been reported, they may represent a separate mutation.

Contracture↗

PubMedDate not supplied

Results of posterior iliopsoas transfer for hip instability caused by cerebral palsy.

The incidence of subluxation or dislocation of the hip in 185 cerebral palsied patients was 25.4%. Posterior iliopsoas transfer will decrease hip deformities but complications such as weakness of hip flexion or abduction contracture are to be expected in some cases. Posterior iliopsoas transfer did not give uniformly satisfactory results; 9 out of 17 patients were fair to poor even combined with innominate osteotomy and/or versus derotation osteotomy of the femur. Early prophylactic surgery of lesser extent such as adductor release is desirable since treatment of established subluxation or dislocation is often unsatisfactory.

Casts, Surgical↗

PubMed2000

Assessment of hip rotation after gait improvement surgery in cerebral palsy.

Sixteen children with diplegic type of cerebral palsy and spastic internal rotation gait were evaluated using gait analysis before and an average of 3 years after multiple soft tissue surgery. Significant correction of the internal rotation gait was observed after multi-level soft tissue surgery which included medial hamstring lengthening in all cases. Our results suggest that for children with spastic internal rotation gait, multi-level soft tissue surgery effectively corrects the dynamic internal rotation gait in the absence of fixed bony rotational deformities.

Adolescent↗

PubMed1983

Part I. Amyoplasia: a common, sporadic condition with congenital contractures.

A specific congenital contracture (arthrogryposis) syndrome has been recognized in 135 out of 350 patients with various kinds of congenital contractures. This sporadic syndrome, designated amyoplasia is characterized by absence of limb muscles that are replaced by fibrous and fatty tissue. At birth there is characteristic positioning of the limbs with internal rotation at shoulders, extension at elbows, and flexion of the hands at the wrists. Severe equinovarus deformities of the feet are usually present. Contractures at knees and hips occur in a variety of positions. Typically, the face is round with a frontal midline capillary hemangioma and slightly small jaw. Intelligence is normal. Approximately 63% of our patients had involvement of four limbs (almost always symmetrically), 24% mainly of lower limbs, and 13% mainly upper limbs. Typically, no other malformations are present. However, minor anomalies are seen often, and include hypoplastic digits and hypoplasia of scrotum or labia, the umbilical cord may be wrapped about a limb at birth. In utero fetal activity is decreased and breech delivery is increased in amyoplasia. All cases were sporadic; identical twins are discordantly affected.

Adolescent↗

PubMed2006

[Ehlers-Danlos syndrome with concomitant joint contractures].

We present 6 children with Ehlers-Danlos syndrome (EDS) with concomitant joint contractures. In 3 of them bilateral clubfeet together with hip, and (or) knee, or wrist flexion contractures were observed. In all of them, after initial soft tissue surgery for clubfeet, reccurences were noted requiring another surgery. Clubfeet were the only manifestation of joint contractures in another 2 children. In one of them soft tissue surgery was succesful, in the second a hypercorrection was noted. One child with EDS had a recurvatum knee deformity which was succesfully treated conservatively. We speculate on two different forms of EDS with joint contractures: a mild one, in which clubfeet are the only joint contractures, and in which a soft tissue surgery may lead to overcorrection, and a severe one, with multiple joint contractures like in arthrogryposis multpiplex congenita, in which soft tissue surgery for clubfeet and joint contractures may lead to reccurences.

Adolescent↗

PubMed1995

Hemicorporectomy.

Intractable decubitus ulcers and femoropelvic osteomyelitis are rare sequelae of paraplegia. Therapy for these conditions ranges from the simple to the complex, including wound debridement and care, alimentary and urinary tract diversion, hip disarticulation, and myofasciocutaneous rotational flaps. Should the condition be recalcitrant to these modalities the only curative therapy is hemicorporectomy. A 28-year-old rendered paraplegic 3 years ago presented manifesting sepsis; marasmus; hip and knee flexion contractures; suppurative sacral and femoropelvic decubitus ulcers, exposed bone, and osteomyelitis; and fecal and urinary incontinence. Pre-operative nutritional supplementation, wound debridement and care, and psychological counselling were provided. Hemicorporectomy was performed, including colostomy, ureteroileal conduit, gastrostomy, and translumbar amputation. Several anatomical, physiological, and operative-technical perspectives are emphasized: a two-staged approach may be preferable--at the first setting an intra-peritoneal exploratory celiotomy with alimentary and urinary tract diversion; and at the second setting an extra-peritoneal hemicorporectomy; preservation of abdominal wall musculature and fasciae to facilitate wound closure; sequential and bilateral ligation of the arteriae et venae iliaca communis; translumbar amputation between the fourth and fifth lumbar vertebrae; extirpation of the fourth lumbar processus spinosus vertebrarum; closure of the dura mater and translation of musculi sacrospinalis into the vertebral canal; avoidance of hypervolemia and hyperthermia; avoidance of wound pressure; testosterone replacement therapy for eunuchism; and physical and occupational rehabilitation including adaptation to a customized bucket prosthesis.

Adult↗

PubMed1989

Limb reduction defects in over one million consecutive livebirths.

Limb reduction defects occurring among 1,213,913 consecutive livebirths in British Columbia during the period 1952-1984 inclusive were reviewed. A total of 659 cases of limb reduction defects were identified, 393 of them involving the long bones and 190 of them more than one limb. The time period 1966-1984, during which ascertainment was consistent, was evaluated, and an incidence of 5.97 per 10,000 livebirths (1 in 1,692 live births) was found. The data were evaluated for trends over time, sex ratio, and regional and ethnic distribution. Associated anomalies of other organ systems in these cases were analyzed, and overall about one-half of the cases have additional defects. The majority of these additional defects affect the musculoskeletal system and include such entities as clubfoot, hip dislocation, and congenital contractures. Defects are also frequent in other organ systems, such as the cardiovascular, gastrointestinal, and genitourinary systems. By far the most common limb defects are terminal longitudinal defects then terminal transverse defects. Of all cases of limb defects, 75% are upper limb and 25% lower limb. We found no evidence that one side is affected more frequently. About 6.5% of cases had another family member registered with a skeletal defect; 12.9% of cases died within the first year of life, the majority (85%) of those dying having additional defects. Etiological considerations are discussed for some subgroups.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗

PubMed1981

The changing concept of infantile scoliosis.

A description of infantile scoliosis is presented. It is thought to be provoked by persistent nursing of the infant during the first months of life in an oblique supine position. In addition deformities of the head, thorax, pelvis and contractures of the neck, hip and feet are often observed: the so-called "Seven-point syndrome". Following introduction of the prone-lying position as a prophylactic measure the incidence of infantile scoliosis has decreased considerably in Germany. The oblique positional scoliosis ("resolving") is probably a separate entity. It is not clear, however, whether it may occasionally become progressive or whether the progressive forms represent the lower end of the spectrum idiopathic adolescent, juvenile and infantile scoliosis.

Humans↗

PubMed1997

Clinical evaluation of a new orthosis, the 'walkabout', for restoration of functional standing and short distance mobility in spinal paralysed individuals.

The Walkabout orthosis is a relatively new device for assisted standing and mobility in spinal paralysed individuals. The design, with a medially-mounted single-axis hinge joint linking two knee-ankle-foot orthoses, is quite different to other currently available orthoses which have laterally positioned hip joints such as the Reciprocal Gait Orthosis or Hip Guidance Orthosis. Twenty-five spinal cord injured patients were fitted and trained with the Walkabout orthosis and followed up regularly for just under 2 years on average. Sixty percent of all the patients fitted have incorporated use of the Walkabout orthosis into their lifestyles. Maintenance of joint mobility and psychological benefits were the most important outcomes of Walkabout usage. Loss of thoraco-lumbar mobility was found to be a limiting factor in successful use of the Walkabout orthosis in patients without active hip flexion. Patient selection criteria should include demonstrated spinal stability without significant deformity, controlled muscle spasm, less than 5 degrees of hip or knee flexion contracture, achievable neutral ankle position, mobility of the thoraco-lumbar spine into lateral flexion, good upper limb strength, and motivation with realistic expectations.

Adult↗