Early X-ray Diagnosis of Congenital Dislocation and Developmental Dysplasia of the Hip in Newborn and Infant / 实用放射学杂志

Objective To study the diagnostic method with computed radiography for congenital dislocation of the hip(CDH) and developmental dysplasia of the hip(DDH) in early stage in newborn and infant.Methods Followed-up with computed radiography made a comparison between 47 abnormal hips (CDH and DDH ) in 26 infants ,and 60 normal hips in 30 infants.Results (1)The normal pattern of acetabulum in neonate and infant appeared as definite“—”,indefinite“—” was considered as abnormal,its sensitivity,specificity and accuracy was 100%,91.59 and 85% respectively,and statistical comparison P

The Innominate Osteotomy in Congenital Dislocation of the Hip / 대한정형외과학회잡지

Beyond the usual age of walking, the dysplasia of dislocated hip has become severe and its reversivility limited so that the reduced hip cannot maintained in stable position. The innominate osteotomy redirect cartilage of the hip and provide stability in the functional position of walking. The author have experienced 45 cases out of 42 patients with congenital dislocation of the hip who were treated by innominate osteotomy at Department of Orthopedic Surgery College of Medicine Yonsei University from Jan. 1979 to Dec. 1986. The analysis of result of operation has been Jan. 1979 at least 18 months follw-up study. 1. The mean age was 4.2 years ranging fron 18 months to 14 years.2. The mean value of parameters in preoperative evaluation, acetabular index was 37°, neck shaft angle 146°, CE angle −64° and leg length discrepency 1.5cm. After operation, actabular index was 20°, neck shaft angle 137° and CE angle 39° in average. And operated limb was longer as 0.5cm in average. 3. By anatomical assessment of NcKay, 17 cases were graded excellent, 19 cases good, 7 cases fair and 2 cases poor. Especially among the patients above 6 years old, only 6 cases were graded excellent or good. 4. As to the post-operative complication, limitation of motion was noted in 4 cases, redislocation in 2 cases, subluxation in 1 cases, avascular necrosis of femoral head in 1 case and infection in 1 case.

A Clinical Analysis on Treatment of Congenital Dislocation of the Hip in Old Childhood / 대한정형외과학회잡지

It is well known the early diagnosis and early treatment is very important for the patient with congenital dislocation of the hip(CDH) to provide a favorable function in the whole life. However, despite screening programmes for the detection of CDH, children with dislocated hip continue to present late. While there has been general agreement as to the need for treatment of persistent acetabular dysplasia secondary to CDH, the appropriate treatment has been a matter of controversy for many years, and the surgical treatment of CDH in old children presents a more formidable technicalchallenge than in younger child. The author studied 26 cases in 23 patients of CHD aged between 6 years and 13 years at the Department of Orthopedic Surgery of Yonsei University during a 6 year period from January, 1979 to December, 1984. The aim of this study was to find out available surgical treatment for the old childhood with CDH and to assess the comparative results of age, degree of acetabular dysplasia and the station of femoral head displacement. The results of this study are are as follows; l. Among the 23 patients, female was 20 patients, male was 3 patients and 3 female patients show bilateral involvement. And among 26 cases, left hip involvement was 21 cases and right hip involvement was 5 cases. 2. Age at initial operation was 8 years and 10 months in average ranging from 6 years and 2 months to 13 years and 4 months, and average follow-up time was 3 years and 11 months ranging from 1 year 6 months to 5 years 2 months. 3. Attended type of surgery of the CDH in old childhood were 4 cases of Salter's innominate osteotomy, 5 cases of Sutherland's double innominate osteotomy, 5 cases of Salter's innominate osteotomy with femoral shortening and 12 cases of Klisic procedure. 4. Age of the patient as well as degree of acetabular dysplasia and station of femoral head displacement may influence on determination of type of the surgical procedure. 5. The older the age at initial operation and the more the displacement of femoral head, the results was less favorable. 6. As in young childhood, the clinical results of treatment are invariably better than the radiological results. 7. Overall final results of leg length discrepancy was 1.0cm in length and range of leg length discrepancy differs from type to type of surgical procedure. 8. Complications developed after treatment were avascular necrosis of femoral head in one case, fracture of the ipsilateral femure in 3 cases and wound infection in 1 case.

Measurement and Meaning of the Change of Acetabular Angle and Femoral Anteversion in Congenital Dislocation of the Hip / 대한정형외과학회잡지

Recently, the treatment principles of congenital dislocation of the hip has been altered markedly. The importance of concentric reduction and its maintenance during growth period in CDH has been stressed by many authors. Acetabular remodelling capacity has been argued between many authors, because it was critical criteria about the determination of operating period and methods. Authors selected 25 cases of congenital dislocation of the hip, which was treated by closed reduction, open reduction and femoral osteotomy to obtain concentric reduction of the hip. And we analyzed the change of acetabular angle and femoral anteversion in two group: Group 1-below 2 years and Group 2-from 2 years to 4 years old. The results were as follows: 1. The change of acetabular angle was improved markedly: average 15° in the Group I and average 13° in the Group 2 in 2 years. 2. The change of femoral anteversion in the Group I was markedly improved: average 15°, but, the in the Group 2 was not significant: average 6°. 3. It was thought that the perfomance of femoral osteotomy without innominate osteotomy in the Group 2, could achieve the satisfactory acetabular remodelling.

The Treatment of Bilateral Congenital Dislocation of the Hip / 대한정형외과학회잡지

There are few reports in the literature on how to care and manage bi!ateral congenital dislocation of the hip. Six patients have been encountered at this hospital from June 1979, of them four children had operative treat ment and the other two conservative. As a result of our experience about the management of bilateral congenital dislocation of the hip. The authors obtained the following conceptions; 1. The patient with bilateral dislocation was rather delayed in diagnosis. Therefore, in comp the treatment of bilateral cases was poorer than that of unilateral case. 2. In the case of the dislocated hip that might be easily reduced and maintained in the stab servative care was usually recommeded even in the older child. Unstable, unreduced hip,; hip in old children, the more definitive operation and internal & external rigid immobilization mandatory to get good result. 3. It might be beneficial to operate the more deformed and resistive hip first, and then to p with the same procedure 2 weeks after the first operation.

A Clinical Study of Congenital Dislocation of the Hip / 대한정형외과학회잡지

The congenital dislocation of the hip is one of the most common congenital disease in the field of the orthopedic surgery. For the normal development of the acetabulum and femoral head, the displaced femoral head shouid be replaced in the acetabular socket as early as possible. In most cases treated in proper time, closed reduction is successful. If not, operative correction will almost always be necessary due to abnormal changes of the acetabulum and femoral head. We experienced 33 cases in 32 patients of the congenital dislocation of the hip at the Department of Orthopedic Surgery of Hanyang University Hospital from May, 1972 to December, 1980. The results obtained were as follows: 1. The most common aged group at the first visit was ranged from 12 months to 24 months and the preponderance of girl to boy was 3.6:1. 2. The ratio of left to right side was 1.6:1. 3. In delivery history, there were 3 cases of breech presentation, 1 case of Cesarean section and 1 case of prematurity. The associated congenital anomaly was observed in a case of which combined internal tibial torsion and talipes metatarsus varus deformity. 4. In 33 cases in 32 patients, 22 cases were treated conservatively and 11 cases were treated surgically. The results of treatment were excellent in 21 cases, good in 11 cases and fair in 11 case. We experienced 4 cases of neglected congenital dislocation of the hip in the period of late childhood, 3 cases were treated with Chiari osteotomy and the other 1 case was treated with Colonna capsular arthroplasty. The overall results were excellent.