Congenital dislocation of the hip in Finland: An epidemiologic analysis of 1035 cases

The incidence of congenital dislocation of the hip (CDH) and some birth characteristics of the population in Uusimaa county in southern Finland were investigated during the years 1966 through 1975. A total of 1035 babies with CDH was born during the time under review. This was 0.68 per cent of liveborns in the area. In 920 babies, the diagnosis was made during the first month of life, corresponding to 0.61 per cent of liveborns and 89 per cent of all children with CDH. The annual variation was great. The monthly variation of CDH in girls was significant, with a peak in June-July, differing from other investigations. Contrary to results of several other studies, the birth weight of the affected babies was normal. The sex distribution, number of first-born babies, side of the dislocation and associated calcaneovalgus foot were in accordance with findings in most other investigations.     

Congenital dislocation of the hip and its relation to swaddling used in Turkey.

A screening program was initiated and performed at five hospitals in Konya, Turkey from 1988 to 1990. Four thousand one hundred seventy-three infants aged 3-24 months were examined. With this study, we hoped to determine the incidence of and contributing factors to the etiology of congenital dislocation of the hip (CDH) in the central region of Turkey. The overall CDH incidence was 1.34%. CDH occurred about three times more often among girls than boys (40 girls vs. 16 boys). No infant with CDH had been delivered by Cesarean section or breech presentation. No teratologic CDH was detected. The relationship between CDH and swaddling (bundled in extension and adduction) was statistically significant.     

Unsattsfa Ctory Results of Early Treatment of Infants with Unstable Hips at Birth

Among 19,864 infants born in Trondheim between 1 May 1969 and 31 December 1974 instability of the hip joint was diagnosed in 378 (19.03 per thousand live-born). All infants were treated with a Frejka cushion splint, usually for 3 months. In spite of this early treatment, 31 infants (8.2 per cent) developed subsequent signs of CDH. In 20 children the diagnosis of CDH was based solely on radiological criteria, while 11 children also displayed clinical abnormalities, mast often restricted abduction of the hip joint. The prenatal and perinatal condition of the 31 children, with persistent signs of CDH in spite of early treatment, was compared with that of the 347 children who showed no obvious signs of CDH. The former group of patients had a relatively high frequency of hip abnormalities in their families, and an increased frequency of breech presentation at birth, concomitant foot deformities and instability of the hip joint also on the eighth day after birth. It is suggested that infants with unsatisfactory results from the early treatment of unstable hips constitute a separate clinical entity and an especially severe form of CDH.     

Unsatisfactory results of early treatment of infants with unstable hips at birth

Among 19,864 infants born in Trondheim between 1 May 1969 and 31 December 1974 instability of the hip joint was diagnosed in 378 (19.03 per thousand live-born). All infants were treated with Frejka cushion splint, usually for 3 months. In spite of this early treatment, 31 infants (8.2 per cent) developed subsequent signs of CDH. In 20 children the diagnosis of CDH was based solely on radiological criteria, while 11 children also displayed clinical abnormalities, most often restricted abduction of the hip joint. The prenatal and perinatal condition of the 31 children, with persistent signs of CDH in spite of early treatment, was compared with that of the 347 children who showed no obvious signs of CDH. The former group of patients had a relatively high frequency of hip abnormalities in their families, and an increased frequency of breech presentation at birth, concomitant foot deformities and instability of the hip joint also on the eight day after birth. It is suggested that infants with unsatisfactory results from the early treatment of unstable hips constitute a separate clinical entity and an especially severe form of CDH.     

The clinical manifestations and pathomechanics of contracture of the extensor mechanism of the knee.

Experience with thirty-eight Asian children and adolescents who presented with either stiffness of the knee, genu recurvatum, habitual dislocation of the patella or congenital lateral dislocation of the patella showed that all those disorders were manifestations of contracture of the extensor mechanism, which fell into two groups according to the components involved. In Group I the main components affected were in the midline of the limb, namely rectus femoris and vastus intermedius; these patients presented with varying degrees of stiffness of the knee, or worse, with genu recurvatum. In Group II the main components involved were lateral to the midline of the limb, namely vastus lateralis and the ilio-tibial band; these patients presented with habitual dislocation of the patella, or worse, congenital lateral dislocation of the patella. In both groups untreated patients developed secondary adaptive changes such as subluxation of the tibia or marked genu valgum which made operative procedures more formidable and less effective. Release of the contracture should therefore be performed as early as possible.     

Lateral hamstring transfer and gait improvement in the cerebral palsy patient.

A retrospective analysis of twenty-three spastic patients who underwent forty-three transfers of the semitendinosus muscle to the lateral intramuscular septum and of the semimembranosus muscle to the biceps is presented. Decreased knee-flexion deformity as well as improved walking function were achieved in 91 per cent. An unsatisfactory result was associated with complications of the procedure. Only one knee of the forty-three that were operated on showed late genu recurvatum. This procedure appears to be both effective and relatively free of late comlications.     

Recent advances in the prevention, early diagnosis, and treatment of congenital dislocation of the hip in Japan

Results of animal experiments and then of clinical study of newborn infants suggested that the main mechanical factor causing hip dislocation is prolonged tension on the hamstrings and iliopsoas and that each of these muscles has a synergistic effect in the production of hip dislocation during the perinatal period. It was, therefore, presumed that the high incidence of congenital dislocation of the hip (CDH) in Japan might be due mainly to the Japanese tradition of forcibly maintaining the legs of infants in an extended position with a "swathing diaper." The incidence of CDH in Japanese infants prior to 1965 was as high as 1.1%-3.5%. In an attempt to reduce the incidence of CDH, examination of newborns was performed on a national scale. However, early screening methods for hip abnormalities were not adequately reliable in Japan to allow identification of conditions that would later become CDH. In 1975 a national campaign to avoid prolonged extension of the hips and knees of infants during the early postnatal period was initiated. As a result, there has been a remarkable reduction in the incidence of CDH in infants, to less than 0.2%.     

Proximal osteotomy of the tibia for the treatment of genu recurvatum in adults.

Twenty-seven opening-wedge osteotomies of the proximal part of the tibia were performed in twenty-five patients who had genu recurvatum. In sixteen knees, the genu recurvatum was due entirely to osseous deformity. In the remaining eleven knees, it was due to a combination of osseous and soft-tissue deformity; in five, the deformity was predominantly osseous and in six, primarily in the soft tissues (the ligaments and capsule). The average age of the patients was twenty-three years (range, fifteen to fifty-four years). The osteotomy was proximal to the tibial tuberosity in twenty-two knees. In eighteen of these knees, the tuberosity was detached with its patellar ligament and then reattached to the proximal part of the tibia over the block of bone in the opened wedge; in the remaining four knees, the tibial tuberosity was not detached. The osteotomy was distal to the tuberosity in five knees. The patients were followed for an average of 14.5 years (range, three to thirty years). Of the eighteen knees in which the osteotomy had been proximal to the tibial tuberosity and the tuberosity had been detached and then reattached, nine (50 per cent) had a result that was excellent; five (28 per cent), good; and four (22 per cent), fair. Of the four knees in which the operation had been proximal to but without detachment of the tuberosity, one had a result that was excellent; two, good; and one, fair. Of the five knees in which the osteotomy was distal to the tibial tuberosity, one had a result that was good; three, fair; and one, poor. Of the twenty-one knees in which the deformity was entirely or predominantly osseous, eighteen (86 per cent) had an excellent or good result. None of the six knees in which the deformity was predominantly in the soft tissues had an excellent or good result. Patients in whom the deformity was not primarily osseous, and those in whom the operation was distal to the tibial tubercle, were much more likely to have a fair or poor result.     

Congenital hip dysplasia: problems in the diagnosis and management in the first year of life

Eighty-two infants less than 1 year of age who presented with a diagnosis of congenital hip dysplasia have been reviewed. Forty-one infants had a diagnosis of congenital dislocation of the hip (CDH), of which 14 were bilateral cases. Forty-one infants had a diagnosis of acetabular dysplasia, of which none was bilateral. The incidence of breech malposition was higher in the CDH group (34%) than in the acetabular dysplasia group (15%). The metaphyseal edge angle, which accurately discriminates between these two groups, is described. There was evidence of abnormal radiographic development in those children with acetabular dysplasia who were not treated by abduction splintage.     

A fixed-ankle, below-the-knee orthosis for the management of genu recurvation in spastic cerebral palsy.

A fixed-ankle, below-the-knee molded plastic splint designed to maintain the ankle in 5 degrees of dorsiflexion and correct any foot deformity was used on eighteen extremities of twelve children with spastic cerebral palsy and genu recurvatum. After an average follow-up of twenty-six months, the genu recurvatum was well controlled and gait was improved.     

Twenty years of progress in congenital diaphragmatic hernia at the University of Florida

Over the past 20 years the clinical paradigms underlying the care of children with congenital diaphragmatic hernia (CDH) have undergone profound changes. The purpose of this work is to provide an historic review of research and clinical studies related to CDH at the University of Florida (UF) and Shands Children's Hospital during the chairmanship of Edward M. Copeland, III, M.D. and to present our current clinical results. During Dr Copeland's tenure survival for newborns symptomatic with CDH treated at UF/Shands Children's Hospital has improved from less than 20 per cent to 85 per cent. Clinical observations have suggested and research studies at UF using a fetal lamb model have confirmed that fetal distress can occur late in gestation, which may predispose infants with CDH to pulmonary hypertension. However, our patient experience has confirmed that the most significant cause of mortality in human infants is not pulmonary hypertension but iatrogenic injury to their hypoplastic lungs. Strict avoidance of barotrauma in these babies has been the most important clinical advance during these two decades. Significant clinical and research problems remain including defining optimal prenatal care, management of complications during the first few weeks of life, and development of strategies to accelerate lung growth. Dramatic improvements in survival have resulted in children who manifest a number of clinical problems that were not evident when most of these patients died early in infancy. Our experience at Shand's Children's Hospital/UF indicates that feeding problems, respiratory infections, and management of subtle or overt neurologic complications may become major issues for some of these survivors and their families.     

Congenital dislocation of the hip in Western Australia. A comparison of neonatally and postneonatally diagnosed cases

Speculation that neonatally diagnosed congenital dislocation of the hip (CDH) may have a different etiology from cases diagnosed in the postneonatal period has not been examined in Australia because insufficient data have been available. A population-based study of CDH in children up to the age of two years who were born in Western Australia (WA) in 1981, 1982, or 1983 is the subject of this report. Study material comprised cases of CDH from the WA Congenital Malformations Register and denominator data (all births in WA for 1981-1983) from the Health Department of WA. From this material, rates of CDH were calculated for each of the study variables of interest. The rate of CDH was low for babies born to aboriginal mothers, and it is postulated that this may have a cultural basis, possibly in infant carrying postures. Overall, the prevalence of CDH for 1981-1983 was 6.4 cases per 1000 births, with 4.2/1000 diagnosed in the neonatal period and 2.2/1000 in the postneonatal period. Epidemiologic differences were noted between infants diagnosed in the neonatal period and those diagnosed postneonatally; rates of neonatally diagnosed CDH were higher in first births, breech presentation, and postmature infants than were rates of postneonatally diagnosed cases. Bilateral dislocation was more common (45.3%) in neonatally diagnosed cases than in postneonatally diagnosed cases (23.3%). These findings tended to support the idea that the time of diagnosis may define two distinct entities in CDH.     

Congenital dislocation of the hip in the American black

Between 1977 and 1982, 19 cases of congenital dislocation of the hip (CDH) were encountered in black infants. Six of these cases were associated with other anomalies (atypical CDH); 13 were typical CDH. The incidence of complete CDH in the white population studied is 1.5/1000; in the black population studied it is 0.46/1000. The increased incidence in comparison to previous studies may possibly reflect genetic heterogeneity in the control population relative to the African black.     

Genu recurvatum: A complication of prolonged femoral skeletal traction

Summary Genu recurvatum is a rare complication of prolonged skeletal traction. The literature reports very few cases, the majority secondary to wire traction applied to the tibia in the treatment of femoral shaft fractures. A case of genu recurvatum in a 12-year-old girl as a complication of prolonged femoral skeletal traction was treated at the Kobe University Hospital. A proximal open wedge tibial osteotomy using iliac bone grafts was the surgical treatment initiated at the time of diagnosis. Follow-up after 1 year showed recurrence of the genu recurvatum. Early surgical intervention, prolonged casting and application of knee orthosis were all contributory factors in the recurrence of genu recurvatum in our patient. It should be emphasized that extreme care should be taken in treating femoral shaft fractures in children, especially those requiring wire traction in the tibia or femur, in order to prevent genu recurvatum.Zusammenfassung Genu recurvatum ist eine seltene Komplikation langdauernder Skelettextension. In der Literatur sind nur sehr wenige derartiger Fälle berichtet; die Mehrzahl ist sekundär entstanden nach der Behandlung von Femurschaftfrakturen mit Drahtextension an der Tibia. Hier wird bei einem 12jährigen Mädchen über ein Genu recurvatum berichtet, welches als Komplikation einer langdauernden Skelettextension am Femur entstand. Die Behandlung bestand in einer proximalen Schienbeinosteotomie, die keilförmig geöffnet und mit Knochentransplantaten aus dem Beckenkamm aufgeffült wurde. Bereits 1 Jahr später hatte sich schon wieder ein Rezidiv des Genu recurvatum ausgebildet. Zu frühe chirurgische Intervention, lange Gipsruhigstellung und die Applikation einer Knie-Orthese haben das Wiederauftreten des Genu recurvatum bei unserer Patientin offenbar begünstigt. Es wird darauf hingewiesen, daß bei der Behandlung kindlichen Femurschaftfrakturen größte Sorgfalt darauf zu verwenden ist, die Entwicklung eines Genu recurvatum zu verhindern; dies gilt besonders dann, wenn eine Drahtextension an Tibia oder Femur erforderlich ist.     

A sonographic study of the morphology of the preterm neonatal hip

Preterm and low-birth-weight infants are reported to have an increased risk of late presentation of congenital dislocation of the hip (CDH). A sequential sonographic study of hip morphology was made of 82 live preterm infants. Eighty-two matched, term controls were scanned for comparison. The morphology of the hips was similar at birth. The increase in missed CDH cannot be explained in simple morphological terms. Abnormal birth sonograms resolved rapidly in the absence of clinical instability, casting doubt on the role of static sonographic appearances to predict the need for treatment in the immediate newborn period.     

Posterior-Stabilized TKA in Patients With Severe Genu Recurvatum Achieves Good Clinical and Radiological Results at 5-year Minimum Follow-Up: A Case-Controlled Study

BackgroundGenu recurvatum is a rare knee deformity. Total knee arthroplasty (TKA) in severe preoperative recurvatum requires surgical adjustments. Few studies have assessed the clinical and radiological results of TKA in recurvatum. The aim was to compare the clinical and radiological outcomes, complications, and revision rates after posterior-stabilized TKA in severe recurvatum with those without recurvatum.MethodsBetween 1987 and 2015, 32 primary posterior-stabilized TKA were performed with a preoperative genu recurvatum greater than 10° and minimum follow-up of 60 months. In severe genu recurvatum, the extension gap needs to be decreased compared with flexion gap. To achieve this, the distal femoral cut is distalized, whereas the posterior femoral and tibial cuts are performed as usual. They were compared with 64 matched posterior-stabilized TKAs without recurvatum. The demographic data were similar between groups. The clinical and radiological outcomes, complications, and revision rates were assessed at the last follow-up.ResultsAt a mean follow-up of 7.4 years ± 1.9, there was no significant difference in International Knee Score functional score (77.5 vs. 73.4; P = .50) and knee score (86.6 vs. 89.5; P = .37) between the recurvatum group and the control group, respectively. 6 patients had a postoperative recurvatum equal or superior to 10° in the recurvatum group (18.8%). There was no difference between both groups in radiological outcomes, complication, or revision rates. No instability was found in the recurvatum group.ConclusionPosterior-stabilized TKA with controlled distalization of the femoral component in the setting of severe preoperative genu recurvatum achieves good clinical and radiological outcomes at a minimum follow-up of 5 years and similar to TKA without preoperative recurvatum.Level of EvidenceIII.     

Congenital heart disease associated with congenital diaphragmatic hernia: A systematic review on incidence,prenatal diagnosis,management, and outcome

PurposeThe purpose of this study was to evaluate the impact of congenital heart disease (CHD) on infants with congenital diaphragmatic hernia (CDH).MethodsUsing a defined search strategy (PubMed, Cochrane, Embase, Web of Science MeSH headings), we searched studies reporting the incidence, management, and outcome of CDH infants born with associated CHD.ResultsOf 6410 abstracts, 117 met criteria. Overall, out of 28,974 babies with CDH, 4427 (15%) had CHD, of which 42% were critical. CDH repair was performed in a lower proportion of infants with CHD (72%) than in those without (85%; p < 0.0001). Compared to CDH babies without CHD, those born with a cardiac lesion were more likely to have a patch repair (45% vs. 30%; p < 0.01) and less likely to undergo minimally invasive surgery (5% vs. 17%; p < 0.0001). CDH babies with CHD had a lower survival rate than those without CHD (52 vs. 73%; p < 0.001). Survival was even lower (32%) in babies with critical CHD.ConclusionCHD has a strong impact on the management and outcome of infants with CDH. The combination of CDH and CHD results in lower survival than those without CHD or an isolated cardiac defect. Further studies are needed to address some specific aspects of the management of this fragile CDH cohort.Type of studySystematic review and meta-analysis.Level of evidenceLevel III.     

Osteotomia prossimale di tibia nel trattamento del ginocchio recurvato. Tecnica chirurgica

Genu recurvatum is a debilitating deformity characterised by hyperextension of the knee over 15 degrees resulting in an abnormal distribution of the load that can progress during growth and lead to significant deformity and arthrosis if left underestimated. Recurvatum can be osseous, ligamentous, or mixed. Osseous genu recurvatum is usually caused by asymmetrical growth arrest of the proximal tibial physis affecting primarily the tibial tubercle. Here is reported a technique of osteotomy in addition for the treatment of primary and secondary genu recurvatum.