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Ischaemia angle of the newborns Hip

 

The primary objectives of the pilot study were as follows:

  • to analyse whether there is a possibility to detect and observe functional disorders of blood circulation after hip joint immobilization during acetabular dysplasia treatment using various orthosis. Blood circulation disorders may cause serious complications. Usually, ischaemia occurs due to improper treatment or rehabilitation.
  • to check whether there is a possibility to observe functional disorders of blood circulation on each hip joint side regardless orthopedic material being used
  • to check whether each hip joint widening causes closure in the blood vessel surrounding hip joint.

During study, the following changes in venous-arterial surrounding hip joint were noticed:

  • blood vessel closure- a. circumflexa medialis, from the dorsal edge, between greater trochanter and cervix, on the back side of cervix next to shortened muscles at lesser trochanter?( here the closure occurs) and at the groint from the front .

Also, the moment of individual blood vessel closure regarding full widening of each hip joint was examined.  This study aspect included both lateral or side-lying position and groin/back-lying position. As observed, blood vessel closure appears in all cases. The survey result was invariable regardless the position of a child being examined.

Functional disorders of blood circulation mostly appeared when joint hips were abducted from 55 to 90 degrees.

Total vascular occlusion  were observed in 100% of children. Hip joint was abducted from 5 to 20 degrees, up to the maximum (typical newborn baby hip size). In the case of 17 joints, the angle of ischaemia  ranged from 5 to10 degrees. In the case of 4 hips the widening angle amounted to 90 degrees. During examination of the child with hip joint asymmetry and blood circulation disorder diagnosed, the angle of ischaemia amounted to 25 degrees.

During the study, 10 newborn children were examined (7 girls oraz 3 boys).Children’ mothers agreed on the study while the questionnaire and survey were accepted by the Commission on Ethics of Jagiellonian University.

Totally, 36 surveys including 9 children were conducted. One child was too restless and the examination couldn’t have been done. Two doctors from the diverse range of specializations participated in the survey: the orthopaedist who made hip joint widening and examined its ankle and the radiologist was examined blood circulation at hip joint.

Regardless an orthopeadical material being used , Doppler ultrasound can be done, so that a doctor may observe bloodflow in blood vessels at hip joints. If a child wears a splint that keeps the legs in an outward rotated position, like Frejki pillow, lateral or side-lying examination can be done (enough space around greater trochanter).

If a child is in plaster cast widening thighs backwards, the examination at groin position can be done. It will be much easier to use  ultrasonography ending that looks like hockey sticks. Both methods of examination can be done while using  Pavlik harness or Koszla splint.

Orthopaedists have always dreamed about seeing blood supply in hip joints undergoing medical treatment. Currently, not only does this dream come true but there is also the possibility to observe joint blood circulation disorders. This is thanks to experienced, hardworking doctors who studied this issue carefully. Also, technologically advanced equipment was very helpful.

During study it was not possible to find out how the closure in blood vessel appears; as the result of blood vessel stretching or due to pressure appearing during hip joint muscle stretching.

There has also been the attempt to specify the ankle of hip joint ischaemia causing blood vessel closure since feeling the first moment of gentle pressure (muscle resistance) during hip joint widening.

Also, it was not possible to specify the level of the head of the thigh bone ischaemia when blood vessel disorders appear. Those issues require further study.

Firstly, the angle was clinically tested then the goniometer was used.

Gentle hip joint abduction angle measured from the first noticeable resistance doesn’t cause blood vessel closure. Only further legs' widening causes blood vessel closure. In some cases a trace of movements can be observed.

 

Ischaemia angle (between the first one a pressure/resistance can be observed. Then, the hip joint widening until the total blood vessel closure).

 
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