Clinical Observation on Residual Subluxation after Treatment of Congenital Dislocation of the Hip / 대한정형외과학회잡지

Hips with residual subluxation after treatment of congenital dislocation of the hip in children who were admitted in department of orthopaedic surgery, Pusan National University Hospital, from January 1980 to October 1987, are investigated with clinical data, X-ray findings, classification and treatment. Hips with residual subluxation after treatment were followed most commonly by closed reduction and cast immobilization, 15 cases, and by innominate osteotomy, 5 cases. Conservative methods as broom-skick cast or abduction brace were done for the treatment of residual subluxation in all cases, except 2 cases of femoral osteotomies. Degree of improvement was determined by periodically measuring C–E angle, acetabular index, migration percentage and the distance from tear-drop to medial metaphysis of proximal femur. The results were as follow :1. Hips with residual subluxation after treatment were found most commonly after closed reduction and cast immobilization. 2. Residual subluxation was classified as Grade Zero to Grade three by measuring the distance from tear-drop to medial metaphysis of proximal femur. There was 12% of Grade I, 48% of Grade II and 40% of Grade III. 3. The mean normalization periods from Grade I to normal, from Grade II to normal, from Grade III to normal, were 14.7 months, 26.3 months, 37.1 months, respectively. 4. Thirteen cases which more than one and half years of follow-up were possible showed improvements in acetabular index from 30.5°to 22.9°, C–E angle from 5.7°to 25.4° and migration percentage from 34.4% to 18.8%, 5. There were relatively poor results in the hips with residual subluxation after innominate osteotomy.

Femoral Osteotomy for Residual Subluxation of Hip after Reduction of Congenital Dislocation / 대한정형외과학회잡지

It is well known that early diagnosis and early treatment is very important for the patient with congenital dislocation of the hip joint to provide a favorable function in the whole life. The goal of treatment, which is either conservative or operative, is to replace the dislocated hip into the socketand restore its anatomical position. If the head is reduced lately, it may subluxate or redislocate. As a result, secondary osteoarthritis will be complicated in such hips at a laterdate The most cases of congenital dislocation of hip have a increased anteversion and vaglus deformity. It is known that these deformity are cause of redislocation or subluxation, and should be corrected by varus or derotational varus osteotomy to restore for normal cephalocotyloid relationship. We analized 18 residual subluxation of hips which had been treated by derotational varus osteotomy. The results obtained are as follows. 1. Regardless of the age at the time of osteotomy and the amount of varization, the neck-shaft angle corrected to nearly normal in all cases within 3 years after the osteotomy. 2. Acetabular development, indicated by acetabular index, was satisfactory when the osteotomy was done before 4 years, but unsatisfactory in the cases after 4 years of age. 3. Coxa valga epiphysialis of the subluxated head corrected spontaenously after osteotomy in all cases. 4. Subluxated head, indicated by C-E angle and migration percentage, reduced in the cases who had by the derotational varus osteotomy in patients below age of 4 years, but it persisted without further luxation in the cases over 4 years of age.