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4).Other Information Developmental Dyspalasia of the Infant Hip PDF Drukuj Email

 

1: J Orthop Res. 1992 Nov;10(6):800-6. Links

Acute effect of traction, compression, and hip joint tamponade on blood flow of the femoral head: an experimental model.

Naito M, Schoenecker PL, Owen JH, Sugioka Y.

Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan.

Blood flow rates of the canine femoral head were experimentally determined during traction, compression, and hip joint tamponade using the hydrogen washout technique. In puppies, blood flow rate of the femoral head was significantly decreased with either traction or compression applied at one half body weight. Either maneuver, when combined with hip joint tamponade, reduced blood flow rate of the femoral head an average of more than 70% as compared with the initial control rate. In adult dogs, combinations of either traction or compression, at one-half body weight, with hip joint tamponade did not significantly decrease blood flow rate of the femoral head as compared with control values. Perfusion defect of blue silicone could be observed only in puppies around the hip during combinations of traction or compression with hip joint tamponade and involved the posterior superior capital branches of the medial circumflex artery and the arteries in the ligamentum teres. These experimental data may have important implications for the pathogenesis of iatrogenic avascular necrosis in the treatment of congenitally dislocated hip, Legg-Perthes dis1: Orthop Nurs. 1995 Jan-Feb;14(1):33-40. Links

2) Differences in risk factors between early and late diagnosed developmental dysplasia of the hip

P Sharpe, K Mulpuri, A Chan, P J Cundy See end of article for authors’ affiliations

. . . . . . . . . . . . . . . . . . . . . . .

Correspondence to:Ms Sharpe, SouthAustralian Birth DefectsRegister, Women’s andChildren’s Hospital, 72King William Road, North

Adelaide, SA 5006, SouthAustralia; Adres poczty elektronicznej jest chroniony przed robotami spamującymi. W przeglądarce musi być włączona obsługa JavaScript, żeby go zobaczyć.

Accepted 26 October 2005Published Online First6 December 2005

. . . . . . . . . . . . . . . . . . . . . . .

Arch Dis Child Fetal Neonatal Ed 2006;91:F158–F162. doi: 10.1136/adc.2004.070870

Background: Developmental dysplasia of the hip (DDH) is common, affecting 7.3 per 1000 births in South Australia. Clinical screening programmes exist to identify the condition early to gain the maximum benefit from early treatment. Although these screening programmes are effective, there are still cases that are issed. Previous research has highlighted key risk factors in the development of DDH.Objective: To compare the risk factors of cases of DDH identified late with those that were diagnosedearly.Methods: A total of 1281 children with DDH born in 1988–1996 were identified from the South AustralianBirth Defects Register. Hospital records of those who had surgery for DDH within 5 years of life were examined for diagnosis details. Twenty seven (2.1%) had been diagnosed at or after 3 months of age and were considered the late DDH cases (a prevalence of 0.15 per 1000 live births). Various factors were compared with early diagnosed DDH cases.Results: Female sex, vertex presentation, normal delivery, rural birth, and discharge from hospital lessthan 4 days after birth all significantly increased the risk of late diagnosis of DDH.Conclusions: The results show differences in the risk factors for early and late diagnosed DDH. Some known risk factors for DDH are in fact protective for late diagnosis. These results highlight the need for

 

3)Traction at home for infants with developmental dysplasia of the hip.

Hayes MA.

Early treatment of developmental dysplasia of the hip in infants is essential for optimal development of the hip joint. Orthopaedists commonly use a period of preliminary traction before hip reduction to stretch the soft tissues and reduce the risk of avascular necrosis. A program developed at the University of Michigan Medical Center allows the infant to receive traction at home instead of the traditional admission to the hospital. This program has been found to be clinically effective as well as cost effective, and less of an inconvenience to the infant and family than the traditional admission. Intensive involvement by the clinical nurse specialist in teaching and follow-up of each patient is essential for success.

2ease, and avascular necrosis follow

4): Z Orthop Ihre Grenzgeb. 1987 Jan-Feb;125(1):28-34. Links

[Preliminary treatment of congenital hip dislocation using physical therapy based on neurophysiology]

[Article in German]

Niethard FU.

Adductor tightness is a typical symptom in CDH. In cases of subluxation and complete dislocation even a rigid abduction contracture can occur, preventing reduction and favouring redislocation. The contracture of the hip joint is the result of neurophysiological disorders, which can be treated by an exercise program on a neurophysiological basis. 62 children with 73 severely contracted and 5 hypotonic hip dislocations have been treated by the so-called "Vojta-program" before reduction. In a prospective study over 5 years this kind of treatment has been very successful: the incidence of necrosis of the femoral head could be reduced to 4%, long-lasting traction was not necessary anymore and the rigid hip joints required open reduction only in 2 cases.

 

5) : Joint Bone Spine. 2006 Dec;73(6):614-23. Epub 2006 Oct 25. Links

Hip pain from impingement and dysplasia in patients aged 20-50 years. Workup and role for reconstruction.

Langlais F, Lambotte JC, Lannou R, Gédouin JE, Belot N, Thomazeau H, Frieh JM, Gouin F, Hulet C, Marin F, Migaud H, Sadri H, Vielpeau C, Richter D.

Fédération d'Orthopédie, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France. Adres poczty elektronicznej jest chroniony przed robotami spamującymi. W przeglądarce musi być włączona obsługa JavaScript, żeby go zobaczyć.

In the 20-50-year age group, hip pain usually indicates dysplasia. Chronic mechanical pain is the usual pattern, although acute pain caused by avulsion or degeneration of the labrum may occur. The morphological characteristics of the dysplastic hip should be evaluated, and the link between the dysplasia and the osteoarthritis should be confirmed. Three factors indicate a favorable prognosis: joint space preservation, age younger than 40 years, and correctable femoral and acetabular abnormalities. Reconstruction is highly desirable, as it delays the need for joint replacement by 20 years. After 15 years, good outcomes are seen in 87% of patients after shelf arthroplasty and 85% after femoral varus osteotomy with or without shelf arthroplasty. Chiari acetabular osteotomy can be performed in patients with osteoarthritis but is followed by prolonged limping. Periacetabular osteotomy should be reserved for patients with moderate dysplasia and no evidence of osteoarthritis. Shelf arthroplasty and femoral osteotomy require 5-8 months off work (compared to 5 months after hip replacement surgery) but subsequently permits a far more active lifestyle. Hip replacement, which is required 20 years or more after biologic reconstruction, carries the same prognosis as first-line hip replacement (good results in 80% of patients after 15 years). Acute sharp pain related to anterior hip derangement also occurs in primary femoroacetabular impingement (FAI). The most common pattern is cam impingement, which is due to a decrease in head-neck offset and manifests as pain during flexion and adduction of the hip. Cam impingement can be corrected by anterolateral osteoplasty, which is often performed arthroscopically. Pincer-type impingement is contact between the anterior acetabular rim and the femoral neck due to retroversion of the proximal acetabulum. The imaging study strategy is discussed. Coxometry, computed tomography, and arthrography can be used. Primary FAI, which occurs as a result of geometric abnormalities, should be distinguished from secondary impingement. Causes of secondary impingement include exaggerated lumbar lordosis with pelvic tilt and to hip osteophytosis (sports or posterior hip osteoarthritis). Osteoplasty is rarely appropriate in patients with secondary impingement. The features of acute anterior hip derangement are now better defined. They can be used to guide palliative treatment, which is effective, in the medium term at least. Experience acquired over the last two decades has established the efficacy of surgery for hip dysplasia.

 

 

6) : Clin Orthop Relat Res. 2008 Apr;466(4):791-801. Epub 2008 Feb 21. Links

Imaging in the surgical management of developmental dislocation of the hip.

Grissom L, Harcke HT, Thacker M.

Alfred I. duPont Hospital for Children, 1600 Rockland Road, PO Box 269, Wilmington, DE, 19899, USA. Adres poczty elektronicznej jest chroniony przed robotami spamującymi. W przeglądarce musi być włączona obsługa JavaScript, żeby go zobaczyć.

Although the use of ultrasound in the diagnosis and early treatment of developmental dysplasia of the hip (DDH) has reduced the number of patients diagnosed late and decreased the number of operative procedures, surgical treatment is still needed in some patients. Late cases continue to occur as a result of missing the screening examination, being normal at initial screening and missing followup. Dysplasia may persist despite appropriate nonoperative or operative treatment. Many of these patients subsequently undergo closed or open reduction and femoral or acetabular reconstruction. Ultrasound of the hips is generally used up to 6 or 8 months of age, during which time the hips are largely cartilaginous, and radiographs after that time when bony development is more complete. Options to supplement ultrasound and radiography include arthrography, computed tomography, and magnetic resonance imaging. Several advances have been made in the imaging of DDH and its complications including acetabular labral pathology and of femoroacetabular impingement (FAI). We review imaging techniques other than ultrasound used in the management of DDH. LEVEL OF EVIDENCE: Level V, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

 

7) The natural history of developmental dysplasia of the hip after early supervised reatment in the Pavlik harness

A PROSPECTIVE, LONGITUDINAL FOLLOW-UPJ. P. Cashman, J. Round, G. Taylor, N. M. P. Clarke

From Southampton General Hospital, England

Between June 1988 and December 1997, we treated332 babies with 546 dysplastic hips in a Pavlik

harness for primary developmental dysplasia of thehip as detected by the selective screening programmein Southampton. Each was managed by a strictprotocol including ultrasonic monitoring of treatmentin the harness. The group was prospectively studiedduring a mean period of 6.5 ± 2.7 years with follow-upof 89.9%. The acetabular index (AI) and centre-edgeangle of Wiberg (CEA) were measured on annualradiographs to determine the development of the hipafter treatment and were compared with publishednormal values.

The harness failed to reduce 18 hips in 16 patients(15.2% of dislocations, 3.3% of DDH). These requiredsurgical treatment. The development of those hipswhich were successfully treated in the harness showedno significant difference from the normal values of theAI for the left hips of girls after 18 months of age. Ofthose dysplastic hips which were successfully reducedin the harness, 2.4% showed persistent significant latedysplasia (CEA <20°) and 0.2% persistent severe late

dysplasia (CEA <15°). All could be identified by anabnormal CEA (<20°) at five years of age, and manyfrom the progression of the AI by 18 months.Dysplasia was considered to be sufficient to requireinnominate osteotomy in five (0.9%). Avascularnecrosis was noted in 1% of hips treated in theharness.

 

 

 

8J Orthop Sci (2000) 5:540–545

Offprint requests to: S. SuzukiReceived: November 15, 1999 / Accepted: June 5, 2000

Preliminary traction and the use of under-thigh pillows to preventvascular necrosis of the femoral head in Pavlik harness treatment of

developmental dysplasia of the hip

Shigeo Suzuki, Yoichi Seto, Tohru Futami, and Naoya KashiwagiDepartment of Orthopaedic Surgery, Shiga Medical Center for Children, 5-7-30 Moriyama, Moriyama, Shiga 524-0022, Japan

Abstract One hundred and sixty-one hips of 145 patients were treated with the Pavlik harness for developmental

dysplasia of the hip. The patients were divided into two groups. Group A consisted of 65 patients (70 hips) who were

treated between 1980 and 1987. The harness was appliedimmediately after the diagnosis. Group B consisted of 80

patients (91 hips) who were treated between 1988 and 1992.These patients received preliminary traction, and small

pillows supported the lower extremities from just above theknee to the foot to prevent extreme abduction when the

harness was applied. When the distance from the middle pointof the proximal metaphyseal border of the femur to the Y-line

(distance “a”) was 8 mm or more on the initial X-ray picture,the rate of avascular necrosis in group A was 11% and that

in group B was 0%; the difference was significant. However,when distance “a” was less than 8 mm, the rate of avascular

necrosis in group A was 13% and that in group B was 12%,and there was no significant difference. Thus, we suggest that

the Pavlik harness is indicated for developmental dysplasia ofhe hip in which distance “a” is 8 mm or more. Traction should

precede application of the harness, and pillows placed underhe thigh must be used during application.

 

9)

 

: J Pediatr Orthop. 1994 Jan-Feb;14(1):16-23. Links

Changes in soft tissue interposition after reduction of developmental dislocation of the hip.

Tanaka T, Yoshihashi Y, Miura T.

Department of Orthopedic Surgery, Nagoya University School of Medicine, Japan.

Changes occurring in soft tissue interposition in 111 cases of developmental dislocation of the hip (DDH) reduced by overhead traction (OHT) were assessed by arthrogram. Soft tissue interposition was classified into five types based on the shape of the limbus, and changes in tissue thickness in the acetabular floor were examined. Thickness of soft tissue interposition was in the normal range in 92 hips of 111 hips (82.9%), but in hips in which a thick pad of the soft tissue was apparent at the acetabular floor both in the dislocated and reduced positions, soft tissue did not recede in 61.5% of hips.

10)

11)

Free nerve endings in the ligamentum capitis femoris

Michael Leunig1, Martin Beck1, Edouard Stauffer2, Ralph Hertel1 and Reinhold Ganz1

Departments of 1Orthopedic Surgery and 2Pathology, University of Bern, Inselspital, CH-3010 Bern, Switzerland

Tel +41 31 632 2222. Email: Adres poczty elektronicznej jest chroniony przed robotami spamującymi. W przeglądarce musi być włączona obsługa JavaScript, żeby go zobaczyć.

Submitted 99-12-09. Accepted 00-04-16

 

ABSTRACT – We report the presence of free nerve endings (FNE) in the ligamentum capitis femoris

(LCF). Qualitative and quantitative measurements onthe incidence of FNE, as assessed by immuno-histochemistry

for the S-100 protein, were obtained from18 patients undergoing hip surgery. We found FNE in

all LCF, with no association to age. The presence ofFNE in the LCF suggests a role in noci-/proprioception

of the hip.

somatic sense - the faculty of bodily perception; sensory systems associated with the body; includes skin senses and proprioception and the internal organs

somaesthesis, somataesthesis, somatic sensory system, somatosensory system, somesthesis, somaesthesia, somesthesia, somatesthesia

interoception- sensitivity to stimuli originating inside of the body

cutaneous senses, sense of touch, skin senses, touch modality, touch- the faculty by which external objects or forces are perceived through contact with the body (especially the hands); "only sight and touch enable us to locate objects in the space around us"

proprioception - the ability to sense the position and location and orientation and movement of the body and its parts

skin perceptiveness, tactility, touch perception, tactual sensation - the faculty of perceiving (via the skin) pressure or heat or pain

feeling of movement, kinaesthesia, kinesthesia - the perception of body position and movement and muscular tensions etc

12)Surveillance Summaries Temporal Trends in the Incidence of Birth Defects -- United States

As part of its continuing commemoration of CDC's 50th anniversary in July 1996, MMWR is reprinting selected MMWR articles of historical interest to public health, accompanied by current editorial notes. Reprinted below is the report published August 31, 1979, describing trends in the incidence of birth defects in the United States during 1970-1977

 

Table_1

Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

 

TABLE 1. Incidence of selected malformations reported to the Birth Defects Monitoring Program, 1970-1971 and 1976-1977

=======================================================================================================================

Cases Rates*

----------------------- ---------------------

1970-1971 1976-1977 1970-1971 1976-1977

---------------------------------------------- Mean annual

Malformation percent change

-----------------------------------------------------------------------------------------------------------------------

Anencephaly 949 833 5.48 3.94 - 5.4

Spina bifida 1,306 1,053 7.55 4.97 - 6.7

Hydrocephalus 833 925 4.81 4.37 - 1.6

Transposition of great vessels131 175 0.76 0.83 1.5

Ventricular septal defect 770 1,889 4.45 8.92 12.3

Patent ductus arteriosus 686 2,804 3.96 13.25 22.3

Cleft palate without cleft lip 873 1,093 5.05 5.16 0.4

Cleft lip 1,715 1,890 9.91 8.93 - 1.7

Clubfoot 4,756 4,912 27.49 23.21 - 2.8

Reduction deformity 547 705 3.16 3.33 0.9

Hip dislocation 1,382 6,407 7.99 30.27 24.9

Tracheo-esophageal fistula 289 327 1.67 1.54 - 1.3

Rectal atresia and stenosis 648 679 3.75 3.21 - 2.6

Renal agenesis 123 263 0.71 1.24 9.7

Hypospadias 3,565 5,036 40.02 46.22& 2.4

Down's syndrome 1,413 1,590 8.17 7.51 - 1.4

-----------------------------------------------------------------------------------------------------------------------

* Cases per 10,000 total births.

+ Central nervous system.

& Cases per 10m000 male births.

 

13).The development of the ligament of the head of the femur

S. F. Brewster *

Department of Anatomy, Charing Cross and Westminster Medical School, London W6 8RF, England

*Correspondence to S. F. Brewster, Department of Surgery, Bristol Royal Infirmary, Marlborough St., Bristol, Avon, BS2 8HW, England

The hip joints of 30 human male and female fetuses and stillborns between 20 mm and 350 mm crown-rump length were studied by light microscopy.

The ligament of the head of the femur developed in situ as a condensation of mesenchyme at the end of the second month of intra-uterine life (IUL), and was vascularized by branches of acetabular vessels early in the fourth month. In the majority of fetuses older than 5.5 months IUL, vessels in the ligament passed a short way into the femoral head within cartilage canals, to supply a small region around the fovea capitis. The remainder of the head was supplied by vessels in canals from around the upper part of the neck.

The ligament changed from predominantly cellular to fibrous during the last 4 months of IUL. This increase in strength suggested significant mechanical functions in utero: limitation of adduction-flexion and opposition to postero-superior dislocation were the most likely.

 

 

14).Free nerve endings and morphological features of the ligamentum capitis femoris in developmental dysplasia of the hip.

J Pediatr Orthop B. 2007; 16(5):351-6 (ISSN: 1060-152X)

Sarban S; Baba F; Kocabey Y; Cengiz M; Isikan UE

Department of Orthopaedic Surgery, Harran University Faculty of Medicine, Turkey. Adres poczty elektronicznej jest chroniony przed robotami spamującymi. W przeglądarce musi być włączona obsługa JavaScript, żeby go zobaczyć.

A conflict exists on whether the ligamentum capitis femoris has the neuro-morphological structures required for nociception or proprioception of the hip joint. Therefore, we investigated the morphological features and the presence of mechanoreceptors in 24 ligamentum capitis femoris biopsies obtained at open reduction in patients with developmental dysplasia of the hip. Of these 24 hips, 16 were completely dislocated and eight were subluxated. The mean age was 33.8 months (range 13-52 months) at the time of surgery. En bloc ligamentum capitis femoris and pulvinar were taken for biopsy specimen. Ligamentum capitis femoris was dissected and the weight of each ligament was determined using a highly sensitive balance. Specimens were stained with hematoxylin and eosin and Masson trichrome for routine histolopathological evaluation and examined immunohistochemically using monoclonal antibody against S-100 protein. All specimens were graded on a four-grade system according to the amount of coarse-thick collagen bundles and hyalinization. The mean number and type of mechanoreceptors of each specimen were recorded. When the mean age, the patient's weight and the ligamentum capitis femoris weight of each group (completely dislocated vs. subluxated) were compared, there were no significant differences. In the ligamentum capitis femoris of the dislocated hips, the cells were irregularly distributed, had different shapes, and appeared to be in different stages of functional activity. The collagen fiber bundles were thicker than in the subluxated hips, distributed and of varied thickness. The elastic fibers of the dislocated hips were thicker and more numerous than those in the subluxated hips. We found a significant difference between the two groups with regard to the grade of collagen and hyalinization of ligamentum capitis femoris (P<0.004). We found type IVa, free nerve endings in 16 of 24 samples of ligamentum capitis femoris. The 66.6% presence of free nerve endings in the ligamentum capitis femoris suggests a role in nociception/proprioception of the hip in developmental dysplasia of the hip. Interestingly, the percentage and the mean numbers of free nerve endings containing ligamentum capitis femoris were similar in completely dislocated hip group and the subluxated group (62.5 vs. 75%, 12.13+/-9.07 vs. 9.37+/-9.24, respectively). We conclude that the morphological features of ligamentum capitis femoris are influenced by the severity of developmental dysplasia of the hip, whereas the distribution of free nerve endings are not influenced.

 

15).

From Institute of Experimental Research in Surgery, University of Copenhagen,

(Head: H. H. Wandall) andThe Orthopedic Hospital, Department I., Copenhagen, (Head : A. Bertelsen)

with support from Fondet ti1 Videnskabens Fremme.

THE VASCULAR SUPPLY TO

THE FElMORAL HEAD FOLLOWING DISLOCATION

OF THE HIP JOINT

An Experimental Study in New-Born Rabbits

B€l

H. BOHRK, . BAADSGAAaRndD P H.S AGER

It was shown by Langenskjold, Sarpio & Michelsson (1962) that

the characteristic deformities in the acetabulum and the femoral head

following congenital dislocation in man can be produced by traumatic

dislocations of the hip joint in new born rabbits. In the present investigation

similar dysplastic changes have been demonstrated

 

16.

 

The development of the ligament of the head of the femur

S. F. Brewster *

Department of Anatomy, Charing Cross and Westminster Medical School, London W6 8RF, England

*Correspondence to S. F. Brewster, Department of Surgery, Bristol Royal Infirmary, Marlborough St., Bristol, Avon, BS2 8HW, England

 

The hip joints of 30 human male and female fetuses and stillborns between 20 mm and 350 mm crown-rump length were studied by light microscopy.

The ligament of the head of the femur developed in situ as a condensation of mesenchyme at the end of the second month of intra-uterine life (IUL), and was vascularized by branches of acetabular vessels early in the fourth month. In the majority of fetuses older than 5.5 months IUL, vessels in the ligament passed a short way into the femoral head within cartilage canals, to supply a small region around the fovea capitis. The remainder of the head was supplied by vessels in canals from around the upper part of the neck.

The ligament changed from predominantly cellular to fibrous during the last 4 months of IUL. This increase in strength suggested significant mechanical functions in utero: limitation of adduction-flexion and opposition to postero-superior dislocation were the most likely.

17).Pediatric Radiology

 

 

Philip W. Bearcroft, FRCR Laurence H. Berman,#{149}FRCR Andrew H. N. Robinson, FRCS i Gregory J. Butler, MSc

 

Vascularity of the In Vivo Demonstration

 

PURPOSE: To detect the intrinsic blood supply of the unossified neonatal femoral head in vivo by using

 

power Doppler ultrasound (US) and to ascertain whether a reduction in blood flow could be demonstrated

 

with hip abduction. MATERIALS AND METHODS: One hip of 13 neonates was examined with power Doppler sonography. After vessels within the femoral head were identified, the thigh was slowly abducted and the angle at which flow became undetectable was recorded. Spectral Doppler tracings were obtamed in all subjects.

 

RESULTS: Intrinsic blood flow of the femoral head was demonstrated in all subjects. Flow became undetectable during hip abduction in 11 of 13 neonates and reappeared during adduction. The angle at which flow became undetectable varied from 60 to 85.Spectral Doppler signals demonstrated a mixed arterial and venoustrace.

 

CONCLUSION: Power Doppler US provides a simple real-time assessment of the femoral head blood supply. This may prove helpful in identify ing neonates at risk of avascularnecrosis, a complication of treatment of hip dysplasia with abduction hip restraints.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
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