Summary
A retrospective review of sixty children with seventy-eight congenitally dislocated hips who had pre-reduction traction at home was undertaken to assess the effectiveness of the traction and the incidence of severe complications, with specific reference to the incidence and severity of avascular necrosis. Thirty other children with forty-two congenitally dislocated hips who had pre-reduction traction while in the hospital were used as controls. Traction failed to radiologically improve the position of the head in relation to the acetabulum in two hips in each group. The incidence of avascular necrosis was 17.9 percent in hips treated at home and 23.8 percent in hips treated in the hospital. The hospital control group demonstrated higher incidences of the more severe types of necrosis. Traction at home was found to be an advantageous alternative to traction in the hospital, in that it is safe, effective, and less costly; however, it must be stressed that proper patient selection and careful monitoring of the program are required.
Zusammenfassung
Eine retrospektive Studie wurde an 60 Kindern mit einer congenitalen Hüftluxation an 78 Hüftgelenken durchgeführt, bei denen die Extensions-Einrenkungsbehandlung zu Hause durchgeführt wurde. Die Wirksamkeit der Extension und die Häufigkeit schwerer Komplikationen sollte ermittelt werden, insbesondere die Häufigkeit und die Ausdehnung avaskulärer Nekrosen. 30 andere Kinder mit 42 congenital luxierten Hüftgelenken, bei denen die Extensions-Einrenkungsbehandlung im Krankenhaus durchgeführt wurde, dienten als Kontrollgruppe. Bei jeweils 2 Hüftgelenken in jeder Gruppe gelang es mit der Extension nicht, die Stellung des Hüftkopfes gegenüber dem Acetabulum zu verbessern. Die Häufigkeit der avasculären Nekrosen betrug bei den zu Hause behandelten Hüften 17,9% und bei den im Krankenhaus behandelten 23,8%. Bei der letztgenannten Gruppe waren auch die schweren Nekroseformen häufiger. Es hat sich herausgestellt, daß die Extensionsbehandlung zu Hause eine vorteilhafte Alternative zu der Behandlung im Krankenhaus darstellt, weil sie sicher, wirksam und kostensparend ist. Es muß jedoch betont werden, daß eine richtige Auswahl der Patienten und eine sorgfältige Überwachung des Behandlungsprogramms erforderlich sind.
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References
Buchanan J, Green R, Coller J (1981) Management strategy for prevention of avascular necrosis during treatment of congenital dislocation of the hip. J Bone Joint Surg [Am] 63:140–146
Bucholz RN, Ogden JA (1978) Pattern of ischemic necrosis of the proximal femur in nonoperatively treated congenital hip disease. In: Proceedings of the Sixth Open Scientific Meeting of the Hip Society. Mosby, St Louis, pp 43–63
Chapman AH, Loeb DG, Gibbons MJ (1956) Psychiatric aspects of hospitalizing children. Arch Pediatr 73:77–89
Esteve R (1960) Congenital dislocation of the hip. A review and assessment of results of treatment with special reference to frame reduction as compared with manipulative reduction. J Bone Joint Surg [Br] 42:253–263
Gage JR, Winter RB (1978) Avascular necrosis of the capital femoral epiphysis as a complication of closed reduction of congenital dislocation of the hip. J Bone Joint Surg [Am] 54:373–388
Gibson PH, Benson MKD (1982) Congenital dislocation of the hip. Review at maturity of 147 hips treated by excision of the limbus and derotation osteotomy. J Bone Joint Surg [Br] 64:169–175
Joseph K, MacEwen GD, Boos ML (1982) Home traction in the management of congenital dislocation of the hip. Clin Orthop 165:83–90
Kalamchi A, Schmidt TL, MacEwen GD (1982) Congenital dislocation of the hip: Open reduction by a medial approach. Clin Orthop 169:127–132
Kalamchi A, MacEwen GD (1982) Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg [Am] 62:876–888
Mardam-Bey TH, MacEwen GD (1982) Congenital hip dislocation after walking age. J Pediatr Orthop 2:478–486
Salter RB, Kostiuk S, Dallas S (1969) Avascular necrosis of the femoral head as a complication of treatment for congenital dislocation of the hip in young children: A clinical and experimental investigation. Can J Surg 12:44–60
Scott JC (1953) Frame reduction in congenital dislocation of the hip. J Bone Joint Surg [Br] 35:372–374
Staheli LT, Coleman SS, Hensinger RN, Ogden JA, Salter RB, Tachdjian MO (1983) Congenital hip dysplasia. Presentation, 50th Meeting of the Academy of Orthopaedic Surgeons. Anaheim, California
Thomas CL, Gage JR, Ogden JA (1982) Treatment concepts for proximal femoral ischemic necrosis complicating congenital hip disease. J Bone Joint Surg [Am] 64:817–828
Tonnis D (1976) An evaluation of conservative and operative methods in the treatment of congenital hip dislocation. Clin Orthop 119:76–88
Tonnis D (1982) Congenital hip dislocation: avascular necrosis. Thieme-Stratton, New York
Weiner DS, Hoyt WA, O'Dell HW (1977) Congenital dislocation of the hip. The relationship of premanipulaltion traction and age to avascular necrosis of the femoral head. J Bone Joint Surg [Am] 59:306–311
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Voutsinas, S.A., MacEwen, G.D. & Boos, M.L. Home traction in the management of congenital dislocation of the hip. Arch. Orth. Traum. Surg. 102, 135–140 (1984). https://doi.org/10.1007/BF00575221
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DOI: https://doi.org/10.1007/BF00575221