Late congenital dislocation of the hip
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Surgical intervention is essential for untreated congenital hip dislocation in children over 4. Early detection via radiography and prompt surgical treatment are crucial for optimal outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Background:
- Congenital dislocation of the hip (CDH) in children over 4 presents as late untreated or treated displacement.
- Conservative methods are ineffective for untreated dislocations, necessitating surgical intervention.
Purpose of the Study:
- To outline surgical management strategies for late-diagnosed congenital dislocation and subluxation of the hip in children.
- To emphasize the importance of early radiographic detection and surgical intervention.
Main Methods:
- Surgical reduction with femoral shortening for untreated dislocations.
- Innominate osteotomy or femoral derotation osteotomy for subluxating hips based on anatomical defects.
- Varus upper femoral osteotomy or Chiari osteotomy for subluxated hips.
Main Results:
- Surgical reduction is the primary treatment for untreated dislocations, with age limitations for bilateral (up to 7 years) and unilateral (up to 12 years) cases.
- Radiographic signs like a break in Shenton's line and delayed Trendelenburg sign indicate subluxation.
- Femoral shortening may be required to address limb length discrepancies or post-operative issues.
Conclusions:
- Routine follow-up radiography is vital for early detection of acetabular cover loss.
- Surgical intervention should be performed promptly upon detecting any loss of acetabular cover of the femoral head.
Abstract:
Congenital dislocation of the hip in a child over the age of 4 may be discovered as a late untreated displacement, presenting with subluxation or dislocation, or as a late treated displacement presenting as a subluxating or subluxated hip. Conservative treatment is inadequate in untreated dislocations. Surgical reduction is the only possible procedure, associated with shortening femoral. The procedure may be used up to the age of 7 in bilateral cases, and up to the age of 12 in unilateral cases. Subluxating hips are recognised on the anteroposterior radiograph by a break in Shenton's line. A delayed Trendelenburg sign may also been seen. In such cases, innominate osteotomy or femoral derotation osteotomy should be performed, according to the anatomical defects present. Femoral shortening may be indicated in cases of increased length of the lower limb, associated with residual coxa valga or over growth following a previous rotation osteotomy to avoid the mechanical effects on the opposite hip. In cases of subluxated hip, varus upper femoral osteotomy may be indicated, or a Chiari osteotomy in painful hips. It is concluded that routine follow-up radiography is necessary, surgery being indicated as soon as a loss of acetabularcover of the femoral head is detected.