1/328. Central dislocation of the hip with complications. A case of severe central fracture-dislocation of the acetabulum is described. This lesion was complicated by a small-bowel rupture and occlusion of the iliac vessels. In order to reduce the dislocation, iliopubic osteotomy and excision of the hip joint capsule was necessary. ( info) |
2/328. Unsuccessful surgical treatment of hip dislocation in congenital sensory neuropathy with anhidrosis. A case report. A six-year-old girl with congenital sensory neuropathy with anhidrosis (CSNA) presented with bilateral hip dysplasia and subluxation on the right side. Conservative treatment of the hips by closed reduction and a plaster cast was unsuccessful. When aged seven years the patient had an intertrochanteric varus rotation osteotomy on the right side, but subluxation was again evident after five months. A Salter-type pelvic osteotomy was carried out followed by immobilisation, but one year later subluxation was present in the right hip and dislocation in the left. At the age of nine years, the right femoral head resembled a Charcot joint, although walking ability was preserved. In patients with CSNA, surgery may not always be advisable. ( info) |
3/328. Finding patients after 40 years: a very long term follow-up study of the Colonna arthroplasty. Between 1952 and 1965, surgeons at the los angeles Shriners Hospital managed 23 hips with the Colonna two-stage capsular arthroplasty, a procedure originally described in 1936 with very stringent indications for the treatment of childhood hip dysplasia. By using chart review, credit traces, telephone listings software, and the internet, we found 17 (90%) of 19 patients known to be alive 40 years after surgery. Only four of 16 patients questioned have not undergone total hip arthroplasty, and these patients were no better candidates for the Colonna arthroplasty than were the 12 patients who have required hip-replacement surgery. We do not support revival of this now obscure procedure. However, we do attest that the average clinical investigator currently has access to tools that allow reliable location of patients for very long term follow-up. This technology will improve the accuracy and statistical power of outcomes research. ( info) |
4/328. Hip dysplasia in spastic cerebral palsy. Previous reports have noted a relationship between pelvic obliquity and hip dysplasia in spastic cerebral palsy but did not confirm its existence by scientific study. A study is reported that confirms the association of pelvic obliquity with hip dysplasia in spastic cerebral palsy. At presentation of subluxation or dislocation prior to surgery, 80 patients were indexed into five body alignment types. Reclassifications were performed with passage of time in order to study the natural history and effects of surgery. In all cases, hip dysplasia was found to be consistent with the forces related to pelvic obliquity. ( info) |
5/328. 'Floating pelvis'. A combination of bilateral hip dislocation with a lumbar ligamentous disruption. A patient is described with a ligamentous disruption at the L4/L5 level in association with bilateral, traumatic dislocations of the hip. The diagnostic evaluation, acute intervention, and definitive stabilisation are reported. The unstable spine posed a problem in treatment with regard to the timing and technique of the reduction of the hips. ( info) |
6/328. Anterior femoroacetabular impingement after periacetabular osteotomy. As experience with the Bernese periacetabular osteotomy has grown, an unexpected observation in a group of patients has alerted the authors to the risk of a secondary impingement syndrome that may occur some time after the periacetabular osteotomy. This possibly may explain residual pain and limited range of motion in a larger group of patients. The impingement is produced by abutment of the femoral head or head to neck junction on the anterior rim of the properly aligned acetabulum. The symptoms are those of restricted flexion, and limited or absent internal rotation in flexion, with variable groin pain. magnetic resonance imaging studies may reveal acetabular labral disease and adjacent cartilage damage associated with the impingement. Lack of anterior or anterolateral offset between the femoral neck and head results in neck to rim contact when the hip is flexed and/or internally rotated. Before the periacetabular osteotomy this is compensated by the lack of anterior acetabular coverage, but after proper correction the mismatch becomes apparent. The authors recently have devised a routine during the periacetabular osteotomy procedure whereby after the acetabular fragment is corrected into the desired position, the joint is opened, visually inspected, and palpated for impingement with the hip flexed and internally rotated. When necessary, a resection osteoplasty of the femoral neck to head junction is performed to improve the head and neck offset and reduce the anterior contact. This, in the short term, has provided satisfactory prevention of postoperative impingement. ( info) |
7/328. Pseudosubluxation of the hip joint. A case report. The case of a 32-year-old man who had a subluxation of his hip joint after open reduction and internal fixation for an acetabular fracture is presented. The subluxation resolved without surgical intervention. It is thought that the subluxation, herein termed pseudosubluxation, is similar to pseudosubluxation seen in the shoulder. The patient had sustained significant trauma to the abductor musculature and lateral hip region with a Morel-Lavelle lesion and a hip fracture coincident with his acetabular fracture. This entity has not been reported previously. ( info) |
8/328. A rare fracture-dislocation of the hip in a gymnast and review of the literature. Posterior fracture-dislocation of the hip is an uncommon injury in athletics and leisure activities. It is more commonly seen in high energy motor vehicle accidents and occasionally in high energy sporting activities. A rare case is reported of posterior fracture-dislocation of the hip joint that occurred in a young athlete during gymnastics. This unusual mechanism of injury illustrates the great forces sustained by the hip joint of gymnasts. Early reduction and operative treatment led to a congruent and stable hip joint. After rehabilitation, she returned to light sporting activities after six months. ( info) |
9/328. Transtrochanteric curved varus femoral osteotomy for spondyloepiphyseal dysplasia tarda. A case report. A female with spondyloepiphyseal dysplasia (SED) tarda suffered bilateral hip pain since about the age of ten. Her radiographs revealed subluxation and irregularity of the hip joints with acetabular dysplasia. Transtrochanteric varus osteotomy was performed on her left femur at 13 years of age and on her right femur at 14 years of age. The congruities of both hips improved after surgery. At follow-up, she had no pain in either hip even after walking for an extended period. Improved activity in daily life was noted. ( info) |
10/328. The fate of untreated developmental dislocation of the hip: long-term follow-up of eleven patients. Eleven patients with developmental dislocation of the hip who had no treatment other than observation were followed up for an average of 40 years. Nine of the 11 patients had bilateral hip dislocations. None of the hips developed avascular necrosis. overall clinical and functional results were very satisfactory despite uniformly unsatisfactory radiographs. These patients achieved a better quality of life than have many patients of similar age who have undergone surgical treatments aimed at reducing such late-presenting hip dislocations. ( info) |