1. The orthopedic treatment of congenital hip dislocation after the age of 6 months
A.G. Sterian**, C.Dumitrescu*, M.B. Popescu*, M.Carp*, C. Zamfirescu*, A. Ulici**
*„ Grigore Alexandrescu” Emergency Hospital for Children Bucharest
** “Carol Davila” University of Medicine and Pharmacy Bucharest
Congenital hip dislocation (CDH)
Abnormal formation of the hip joint during their early stages of fetal development
Can be diagnosed at birth both clinically and through ultrasonigrapicaly. And X-ray of the pelvis can me measleading because the proximal hip head of the femour osify after 3-4 months of age
The outcome of such illness depends on the age of diagnosis and when did the treatment started, with better results after early treatment
Patients and treatment used
The patients included in the study were all older than 6 month of age, and were refferd as healthy babyes before the diagnosis was made. The delay in diagnosis was after an incorrect orthopedic exam or because of late presentation to the doctor
The treatment consisted of adductor muscles tenotomy and cast imobilisation for 6 weeks followed by Pavlik harness until walking age
The cast was applied in 90 degrees of flexion, 45 adduction and neutral rotation
No traction was used before procedure
The biggest chalange at this age is avoiding AVN secondary to forcefull reduction manuveurs that generates compresion forces on the femoural head and compress the medial circumflex artery against the iliopsoas muscle 1,2,3
Results
All patients had good outcome and when walkin began no functional deficit was observed
The x-ray showed the proximal epiphysis of the femur centered in the acetabulum and situated in the inferomedial quadrant, continuous Shenton line and normal coverage angle
Clinnicaly no Trendelenburg gait was observed and no active or pasive loss of motion was measured
Discutions
Although closed reduction and cast treatment is contraindicated at this age because the risk of AVN is very big all the patients treated this way had good results without any residual necrosis
1 Kruezynski J: Avascular necrosis after nonoperative treatment of developmental hip dislocation: Prognosis in 36 patients followed 17–26 years. Acta Orthop Scand 66:239–244, 1995
2 Schoenecker PL, Bitz DM, Whiteside LA: The acute effect of position of immobilization on capital femoral epiphyseal blood flow.J Bone Joint Surg 60A:899–904, 1978.
3 Gage JR and Winter RB: Avascular necrosis of the capital femoral epiphysis as complication of closed reduction of congenital dislocation of the hip. A critical review of twenty years’ experience at Gillette Children’s Hospital. J Bone Joint Surg 54A:373–388, 1972.