Mistakes and complications in the conservative treatment of congenital hip dislocation in children

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Abstract

Retrospective analysis of treatment of 183 patients, aged 1 month-18 months, with congenital hip dislocation was performed. 146 patients had failed hip reduction. It was detected that in 134 cases (91.8%) inadequate treatment and/or wrong management and behavior of parents took place. Failed treatment with Frejka pillow, abductive splint, Pavlic device, functional plaster bandage, closed reduction were considered. Main mistakes in application of those methods as well as violation of treatment tactics were described. It was shown that repeated failed femoral head reductions were unfavorable factors for the following development of hip joint.

About the authors

O. A. Malakhov

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

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

I. V. Levanova

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

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

S. E. Kralina

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

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

V. D. Sharpar

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

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

References

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Supplementary files

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2. Fig. 1. An example of inadequate treatment in a Frejk pad type vent pad. Patient A. 3 months old, diagnosis: congenital supraacetabular dislocation of the femoral head.

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3. Fig. 2. An example of inadequate treatment in the outlet splint. Patient D., diagnosis: congenital supraacetabular dislocation of the hips. a — at the age of 1 month; b — X-ray control at the age of 7 months in a functional plaster cast: the head of the left femur is located behind the posterior edge of the acetabulum; c — when applying to CITO at the age of 1 year 3 months: dislocation in the left hip joint persists.

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4. Fig. 3. An example of inadequate treatment in a functional plaster cast. Patient Ch., diagnosis: congenital supraacetabular dislocation of the head of the left femur. a — at the age of 1 month; b — X-ray control at the age of 7 months in a functional plaster cast: the head of the left femur is located behind the posterior edge of the acetabulum; c — when applying to CITO at the age of 1 year 3 months: dislocation in the left hip joint persists.

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5. Fig. 4. An example of inadequate treatment with massage and therapeutic exercises. Patient M., diagnosis: congenital dislocation of the right hip. a — at the age of 1 month; b — X-ray control at the age of 3 months: progression of dysplasia of the right hip joint.

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6. Fig. 5. Complications after closed reduction of the femoral head. a — patient S., 2.5 years old, diagnosis: congenital hip dislocation. Condition after repeated closed reduction. Aseptic necrosis of the heads of both femurs, flexion-abduction contractures in the hip joints; c — scars in the popliteal region in patient S. 2.5 years after fixation in an unlined plaster cast. b — patient B., 3 years old, diagnosis: congenital hip dislocation. Condition after repeated attempts to reduce. Aseptic necrosis of the head of the left femur, resulting contracture in the left hip joint;

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7. Fig. 6. Long-term result of treatment of patient V. (first group). a — at the age of 8 months: acetabular dislocation of the femoral heads; b — treatment in a functional plaster cast: reduction was achieved 1 month after the start of treatment; c — at the age of 1 year 6 months: the development of the hip joints corresponds to the age norm; d — clinical and radiological result at the age of 10 years: complete compensation of the function of the hip joints.

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8. Fig. 7. Long-term result of treatment of patient D. (second group). a — at the age of 4 months: acetabular dislocation of the femoral heads; b — at the age of 7 months: inadequate treatment in the abduction splint (before admission to the CITO), the femoral heads are located outside the acetabulum; c — at the age of 9 months: reduction was achieved during treatment in a functional plaster cast; d — at the age of 1 year 9 months: the development of the hip joints corresponds to the age norm; e — clinical and radiological result at the age of 13 years: subcompensation of the function of the hip joints; formation of residual subluxation of the femoral heads, more pronounced on the right.

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