- Discussion:
-
Pavlik harness is usually not successful in children > 6 months (crawling age);
- this is mainly due to increased activity levels of the child as well as
the fact that these children begin to learn how to remove the harness;
- reduction of hip may be complicated when hip capsule becomes permanently
elongated, and when
psoas tendon obstructs reduction of the femoral
head into acetabulum;
- questions to be answered:
- whether mild dysplasia is present
- whether the femoral head is subluxated or dislocated
- whether manipulative reduction has been helpful;
- to what extent any soft tissues within the acetabulum may
interfere with complete reduction of the dislocation;
- position and condition of the acetabulur labrum (limbus)
- Clinical Presentation:
- children in this age group often are initailly seen with a shortened
extremity, limited passive abduction, and a positive Galeazzi sign;
- if the child is walking a T berg gait will be present;
- Radiographs:
- delayed ossification of femoral head;
- lateral & proximal displacement of femoral head;
- shallow acetabulum;
- w/ persistent dysplasia, femoral head moves superiorly & laterally;
- coxa valga;
- Arthrogram:
- may reveal interposition of soft tissue in the acetabulum (suggested by
lateralization of the femoral head);
- CT Scan:
- femoral head becomes reduced in size;
- posteromedial flattening
- excessive anteversion;
- Treatment Options:
-
closed reduction w/ traction & spica casting;
-
open reduction;
- if reduction is not achieved easily or if hip is not stable in 90-100 deg
of flexion & 45-55 degrees of abduction, then open reduction is necessary;
Congenital dislocation of the hip in the older child. The effectiveness of
overhead traction.
Acetabular development after closed reduction of congenital dislocation of the hip.
Closed reduction for congenital dysplasia of the hip. Functional and
radiographic results after an average of thirty years.
Congential hip dislocation after walking age.
TH Mardem-Bey and GD MacEwen.
J. Pediatric Orthopaedics. Vol 2. 1982. p 478.
One-stage treatment of congenital dislocation of the hip in older
children, including femoral shortening.
