Open reduction and varus-detorsion osteotomy with femoral shortening in treatment of congenital dislocation of the hip

In this study, we clinically and radiographically evaluated open reduction with shortening of the femur in children more than 1 year old with refractory congenital dislocation of the hip. In 19 children (aged 1-4 years), 22 joints were operated on. The patients were followed-up for an average of 8.7 years (range, 2-13 years). Functional results were satisfactory in all joints, and differences in limb length were not significant. Radiographically, good results (grades I and II) were obtained in 16 of the 22 joints, according to Severin's criteria. This surgical procedure may be indispensable for treating refractory congenital dislocation of the hip in children over 1 year old.     

Morphology of untreated bilateral congenital dislocation of the hips in a seventy-four-year-old man

Two untreated completely dislocated hips were examined pathologically in a 74-year-old male dissecting room cadaver. The femoral heads bilaterally were 9 cm above the acetabular fossae. They lay adjacent to each ilium with no secondary acetabulum formation. A thickened and markedly elongated fibrous capsule appeared to be the major structure that had checked further migration of the femoral heads during weight-bearing. The femoral heads, although slightly flattened medially and somewhat smaller in size than in the normal adult, showed no degenerative arthritis. Dysplastic acetabular fossae were filled with soft tissue. Bone-to-bone contact with secondary degenerative changes was present only where the femurs, at the level of the lesser trochanters, rubbed against the overhanging superior acetabular rims.     

Combined treatment of crural shortening and calcaneus-malleolar conflict using the Ilizarov distractor

The complex mode of treatment for crural shortening and calcaneus-malleolar conflict with Ilizarov distractor in 3 children is presented. The management resulted in fast ossification of the distal tibial epiphysis, adequate position of displaced lateral malleolus and correction of the tarsal varus as well as angular deformity of the tibia. The importance of timing for this kind of treatment is emphasized by the author.     

Bilateral anterior dislocation of the hips. A case report

A case of traumatic bilateral anterior dislocation of the hips complicated by a femoral head fracture is described. The mechanism is discussed and the literature reviewed.     

A method for open reduction and internal fixation of the unstable posterior sternoclavicular joint dislocation

Posterior sternoclavicular joint (SCJ) dislocations are most often stable after reduction but may be associated with significant complications related to the location of the medial head of the clavicle within the mediastinum. In rare instances, a posterior SCJ dislocation is irreducible or redislocates after a closed reduction. Because of the potential hazards related to compression of vital structures within the superior mediastinum, open reduction and internal fixation is usually required. Although open reduction is widely accepted as the method of choice, the best method for achieving stable fixation remains unanswered. We present the case of an unstable SCJ stabilized, in anatomic position, with two large-bore cannulated screws in conjunction with open reduction. We believe that the risk of hardware migration reported with the use of pins and wires and its catastrophic complications are greatly minimized using our technique.     

An evaluation of conservative and operative methods in the treatment of congenital hip dislocation

An evaluation of different methods of closed reduction of dislocated hips during different periods of time shows that manual reduction and fixation in Lorenz position account for a high rate of avascular necrosis. Even with functional and slow reduction by Pavlik harness and overhead extension, there is still a certain percentage of femoral capital necrosis. The fetal position recommended by Fettweis and Salter seems to reduce the incidence of necrosis. Acetabuloplasty combined with detorsion-varus-ostcotomy provides the means of normalizing a hip joint with a greater degree of success than most other methods.     

Ultrasonography in the management of painful hips in children

It has been suggested that nitric oxide could be implicated in the pathogenesis of Alzheimer's disease (AD). Recently Kuiper et al. reported decreased CSF nitrate levels (oxidation product that provides an indirect estimation of nitric oxide) in AD patients, assessed with a colorimetric method. However other group, using a microplate version of the Griess reaction, did not confirm these findings. We studied the CSF and plasma levels of nitrate with kinetic cadmium-reduction method in 32 AD patients and 36 matched controls. The CSF and plasma nitrate levels did not differ significantly between the two study groups. CSF and plasma nitrate levels did not correlate with age at onset and duration in the patient group. These data suggest that CSF and plasma levels of nitrate are apparently unrelated with the risk for AD.     

Total avascular necrosis of the capital femoral epiphysis in congenital dislocated hips

Ninety-four hips involved with total avascular necrosis in the treatment of congenital dislocation of the hips were reviewed in a search for etiological factors and effective salvage procedures. Pre-reduction traction and adductor tenotomy did not prevent avascular necrosis. Abduction of the hip in the "frog" position was the incriminating common denominator. This position may cause (1) interference of the blood supply to the femoral head by compression of the medial branch of the deep profundus artery; and (2) pressure on the intraepiphyseal grooves by the glenoid labrum. The containment of the femoral head by acetabuloplasty (preferably) below age 8, followed at a later date (over age 10) by transfer distally of the greater trochanter, with the abductor muscles, offers a satisfactory salvage procedure.     

Surgical treatment of congenital hemolytic anemia in children

In the paper, an experience with surgical treatment of 67 children suffering inherited spherocytosis is summarized. In most patients the first signs of the disease appeared in early age. It is concluded that splenectomy is indicated in all children with inherited spherocytosis irrespective of the form of the disease at the age from 3 to 5 years. In a grave course and the appearance of signs of functional hepatic insufficiency the operation should be accomplished as earlier as posisble.     

Traumatic hip dislocation with spontaneous reduction and capsular interposition. A report of 2 children

We present 2 cases of posterolateral hip dislocation in children followed by spontaneous reduction and interposition of soft tissue. After reduction of a dislocated hip joint, interposition of soft tissues or fracture fragments must be excluded. When reduction has occurred spontaneously, the condition may be misjudged, correct treatment delayed and the hip joint permanently damaged, as occurred in one of our cases. In the second case, prompt surgery was undertaken and the patient recovered completely.