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Torticollis and hip dislocation
1Scottish Rite Children's Medical Center, Atlanta, Georgia 30342, USA.
Insights
Congenital muscular torticollis may be associated with hip dysplasia. This study found an 8% incidence of hip disease in infants with torticollis, lower than previously reported, suggesting targeted screening may be beneficial.
Area of Science:
- Pediatric Orthopedics
- Developmental Pediatrics
Background:
- A potential association exists between congenital muscular torticollis and developmental hip dysplasia.
- The reported incidence of hip dysplasia in children with torticollis varies significantly in existing literature.
Purpose of the Study:
- To determine the actual incidence of hip dislocation or subluxation in patients diagnosed with congenital muscular torticollis.
- To evaluate the necessity of screening for hip disease in all torticollis cases.
Main Methods:
- Retrospective review of 70 patients with congenital muscular torticollis.
- Radiographic assessment of hips in 54 patients.
- Follow-up evaluation of 41 patients at an average age of 3 years and 4 months.
Main Results:
- Six patients (approximately 8%) presented with hip subluxation or dislocation.
- Four of these patients were referred for pre-existing hip disease; two were referred for torticollis and subsequently diagnosed with hip disease.
- No patients exhibited abnormal hip radiographs or physical findings during follow-up.
Conclusions:
- The incidence of hip disease in patients with congenital muscular torticollis is approximately 8%.
- This rate is lower than the commonly cited 20%, suggesting that the association may be less frequent than previously believed.
- Further research may refine screening protocols for hip disease in infants with torticollis.
Abstract:
Reports in the literature suggest that there is an association between two childhood disorders: torticollis, an easily recognized clinical deformity, and developmental dislocation or dysplasia of the hip, an occult disorder. The identification of the obvious disease, torticollis, may prompt a search for the occult disease, developmental dislocation of the hip. If the association of these two disorders is common, it may be justified to expend resources to diagnose the occult disorder in all cases in which the more obviously noticed disorder is recognized. The reported association varies between 2 and 29%. We retrospectively reviewed 70 patients with the diagnosis of congenital muscular torticollis to determine the incidence of hip dislocation or subluxation in these patients. Fifty-four patients had radiographs of their hips. Forty-one patients were available for follow-up at an average of age 3+4 years. Six patients were noted to have hip subluxation or dislocation, all at presentation. Of these, four had been referred for diagnosed hip disease, whereas two were referred for torticollis, and the hip disease was then diagnosed by the pediatric orthopaedist. No patient had abnormal radiographs or physical findings at follow-up. We conclude that the rate of hip disease in those with torticollis is approximately 8% and is lower than the 20% often quoted.