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PubMed1979

Circulatory and vascular changes in the hip following traumatic hip dislocation.

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.

Animals↗
PubMedDate not supplied

The effect of the inverted limbus on closed management of congenital hip dislocation.

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.

Child, Preschool↗
PubMed1979

Growth and development of congenitally dislocated hips reduced in early infancy.

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.

Acetabulum↗
PubMed1979

Traumatic hip dislocation in childhood. A report of 26 cases and review of the literature.

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.

Adolescent↗
PubMed1978

Malignant hyperthermia and central core disease in a child with congenital dislocating hips.

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.

Adult↗
PubMed1978

Femoral shaft fracture with ipsilateral hip dislocation in a child.

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.

Adolescent↗
PubMed1977

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↗
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↗
PubMed1976

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↗
PubMed1977

[Analysis of the metaplastic disturbances in dislocated hip joints in the orthopedic hospital of the Medical Academy in Magdeburg (author's transl)].

One of the most frequent and prognostically unfavorable complications occurring with therapy for dislocated hip joints is a metaplastic disturbance at the coxal end of the femur. We undertook a differentiation between metaplastic disturbances in necrosis of the center of the femur head and restorative disturbances. In the evaluated period between 1964 and 1974, 1298 children (2236 treated hips) were examined. Between 1965 and 1968 when the old, classical therapy for dislocation was employed, we established a metaplastic disturbances rate of 20%. The rate for necrosis of the femur head was 9% and the restorative disturbance rate was 11%. The metaplastic disturbance rate was lowered to 5.65% as a result of the modern, functional, early therapy instituted between 1969 to 1974. Here we established a rate of necrosis for the femur head of 0.45% and a restorative disturbance rate of 5.2%. This falls within the range established by Huber (5.5%) and Unger (6.06%). The possibility of an endochondral dysostosis must always be considered when bilateral restorative disturbances are present. We observed that restorative disturbances always occurred more frequently in connection with dysplasias. We fell that the cause is the endogenous tendency toward restorative disturbances of the center of the femur head. With early therapy, the possibility of a dislocation can, however, be avoided. In contrast to Kiltz, our later results and follow-up examinations indicate a poorer prognosis for necroses of the center of the femur head.

Age Factors↗