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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

The changing signs of congenital hip dislocation.

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.

Age Factors

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

Total avascular necrosis of the capital femoral epiphysis in congenital dislocated hips.

Ninety-four hips involved with total avascular necrosis in the treatment of congenital dislocation of the hips were reviewed in a search for etiological factors and effective salvage procedures. Pre-reduction traction and adductor tenotomy did not prevent avascular necrosis. Abduction of the hip in the "frog" position was the incriminating common denominator. This position may cause (1) interference of the blood supply to the femoral head by compression of the medial branch of the deep profundus artery; and (2) pressure on the intraepiphyseal grooves by the glenoid labrum. The containment of the femoral head by acetabuloplasty (preferably) below age 8, followed at a later date (over age 10) by transfer distally of the greater trochanter, with the abductor muscles, offers a satisfactory salvage procedure.

Acetabulum

[The inguinal incision for the open reduction of congenital hip dislocation (author's transl)].

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.

Femur Head Necrosis

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

Treatment of congenital hip dislocation by muscle release, skeletal traction and closed reduction in older children.

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.

Casts, Surgical

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