Our experience in the treatment of congenital hip dislocation in children of different ages

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Abstract

The experience in treatment of children with neglected congenital hip dislocation is presented. The main principles of management are defined. The successive complex of curative measures including conservative treatment using Ter-Egiazarov-Sheptun functional plaster bandage in children over 6 months is described in detail. In failed conservative treatment the reduction of dislocation is performed using over head technique. In children over 3 years descent of femoral head and reduction of dislocation are carried out on distraction system followed by surgical correction of all dysplastic elements of the hip joint. Technique of detorsion-varus osteotomy with application of distraction system and closed reduction is described. Long-term results were evaluated using CITO score system in 255 patients. Good and satisfactory results were in 91.7% of cases.

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About the authors

O. A. Malakhov

Central Institute of Traumatology and Orthopedics. N.N. Priorov

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Moscow

O. V. Kozhevnikov

Central Institute of Traumatology and Orthopedics. N.N. Priorov

Email: info@eco-vector.com
Russian Federation, Moscow

I. V. Gribov

Central Institute of Traumatology and Orthopedics. N.N. Priorov

Email: info@eco-vector.com
Russian Federation, Moscow

S. E. Kralina

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Email: info@eco-vector.com
Russian Federation, Moscow

References

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2. Fig. 1. Patient M., 1 year old. Diagnosis: congenital dislocation of the left hip, subluxation of the right hip. a — X-ray on admission; b - treatment with a functional plaster bandage according to Ter-Egiazarov-Sheptun; c — X-ray at the stage of treatment; d — X-ray result after 7 years: acetabular index 25°, Wiberg angle 30°, head coverage ratio on the right 1, on the left — 0.9; e — functional result after 7 years: range of motion in the hip joints is complete, Trendelenburg's symptom is negative on both sides;

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4. Fig. 2. Patient X. 2.5 years old. Diagnosis: congenital dislocation of the hips. a - X-ray at admission; b — in the process of treatment according to the “over head” technique; c — after closed reduction and plaster immobilization; d — residual hip subluxations: head coverage ratio on the right 0.4, on the left — 0.7, pathological antetorsion angle on the right 65°, on the left 60°, Wiberg angle on the right — 10°, on the left 5°, vertical correspondence angle on the right 60°, on the left 75°; e — pelvic osteotomy according to Salter and detorsion-varus osteotomy of the femur on the right were performed; f — 4 months after surgery: head coverage ratio on the right 1, Wiberg angle 35°, vertical correspondence angle 90°.

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5. Fig. 3. Patient O. 3 years old. Diagnosis: congenital dislocation of the right hip. a - upon admission; b — bringing down the femoral head in the distraction system; c — after pelvic osteotomy according to Salter and detorsion-varus osteotomy of the femur on the right; (d) X-ray and functional results 1 year after surgery: full range of motion in the hip joints, right acetabular index 20°, Wiberg angle 35°, head coverage ratio 1.

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6. Fig. 4. Patient A. 4 years old. Diagnosis: congenital dislocation of the left hip. a radiograph on admission; b — a detorsion-varus osteotomy of the left femur was performed, a distraction system was applied; c — 1 year after reduction: the joint is stable, head coverage ratio is 1; d — radiographs at the age of 8 years: residual subluxation of the left femur, head coverage ratio 0.6, acetabular index 35°, Wiberg angle 5°; e — acetabuloplasty according to Pemberton on the left; f — functional and radiographic result 2 years after surgery: full range of motion in the hip joints, negative Trendelenburg sign on both sides, left acetabular index 10°, Wiberg angle 35°, head coverage ratio 1.

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