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2 1/2 year old girl presenting with left dislocated hip
Clinical Case: 2 1/2 year old girl presenting with left dislocated hip
Has Your Child been diagnosed with developmental hip dysplasia at walking age?
Managing developmental hip dysplasia after a late diagnosis can be challenging, but Dr Qureshi is here to help. Schedule a consultation today to ensure your child receives the best possible pediatric orthopaedic care. We prioritize your child’s well-being and are dedicated to providing comprehensive support at every stage.
Do hips dislocate in older children?
According to the International Hip Dysplasia Institute, one in five hundred children is born with a dislocated hip. Although some will be diagnosed at birth, many will evade clinical detection and present when the child is walking age and a painless limp or asymmetry in the legs is noted. In children older than six months, an X-ray is a better investigation than an ultrasound to diagnose hip dysplasia. Dr. Assad, Pediatric Orthopedic Surgeon in Dubai, emphasizes the importance of early diagnosis and appropriate imaging techniques for effective treatment.
Can we still attempt a closed reduction?
If the hip is found to be dislocated on X-ray, a closed reduction under general anaesthetic with hip spica application can still be attempted. However, the chances of success reduce with the advancement of patient age.
What are the challenges in treating a late presenting hip dislocation?
The challenge with late presenting hip dislocation is often more than the fact that the ball of the hip joint is not in the socket. The other issues frequently encountered are:
- Barriers to the hip being relocated through manipulation: This is often due to structures being interposed between the ball and socket preventing its relocation.
- Deformity in the femur (thigh bone): Although the leg may be shorter, frequently the thigh bone overgrows and often may not point in the right direction.
- Deformity in the acetabulum (socket): In the absence of the favourable biomechanical influences of the normal hip joint, the empty socket fails to develop and remains shallow.
How does Dr. Qureshi treat late presenting hip dislocation?
Dr. Qureshi passionately believes in correcting all elements of the deformity as well as relocating the hip joint. His favoured approach for late presenting hip dislocation in walking-age children ,that does not respond to closed reduction, is single-stage hip reconstruction. Single-stage hip reconstruction is a comprehensive surgical procedure that addresses all elements of the deformity in late presenting hip dislocation. The key elements are:
- Arthrogram (dye study) to outline the anatomy of the joint and determine whether a closed reduction is feasible.
- Open reduction procedure where the joint is opened to address the factors obstructing the hip from going back into the joint.
- Soft tissue balancing where muscles that are contracted are addressed through lengthening to ensure the hip joint is stable.
- Femoral osteotomy procedure where shortening of the thigh bone is done to help equalize leg lengths and the rotational alignment is also corrected to make the hip joint more stable.
- Pelvic osteotomy procedure, which is usually the most crucial element of maintaining a stable hip and minimising the risk of redislocation by dividing the pelvic bone to bring the socket down to improve coverage of the hip.
- Hip Spica cast, a plaster cast is applied from the upper abdomen down to the ankles leaving the nappy area relatively accessible for hygiene purposes.
Request an Appointment to Consult with Dr. Assad Qureshi
Clinical Case A : 2 year old girl presenting with left dislocated hip
What is the outcome following single-stage hip reconstruction?
According to the International Hip Dysplasia Institute, one in five hundred children is born with a dislocated hip. Although some will be diagnosed at birth, many will evade clinical detection and present when the child is walking age and a painless limp or asymmetry in the legs is noted. In children older than six months, an X-ray is a better investigation than an ultrasound to diagnose hip dysplasia.
Clinical case B : 2 year old boy presenting with dislocation of both hips
Request an Appointment to Consult with Dr. Assad Qureshi
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Frequently Asked Questions
Do hips dislocate in older children?
According to the International Hip Dysplasia Institute, one in five hundred children is born with a dislocated hip. Although some will be diagnosed at birth, many will evade clinical detection and present when the child is walking age and a painless limp or asymmetry in the legs is noted. In children older than six months, an X-ray is a better investigation than an ultrasound to diagnose hip dysplasia.
Can we still attempt a closed reduction?
If the hip is found to be dislocated on X-ray, a closed reduction under general anaesthetic with hip spica application can still be attempted. However, the chances of success reduce with the advancement of patient age.
What are the challenges in treating a late presenting hip dislocation?
The challenge with late presenting hip dislocation is often more than the fact that the ball of the hip joint is not in the socket. The other issues frequently encountered are:
- Barriers to the hip being relocated through manipulation: This is often due to structures being interposed between the ball and socket preventing its relocation.
- Deformity in the femur (thigh bone): Although the leg may be shorter, frequently the thigh bone overgrows and often may not point in the right direction.
- Deformity in the acetabulum (socket): In the absence of the favourable biomechanical influences of the normal hip joint, the empty socket fails to develop and remains shallow.
How does Dr. Qureshi treat late presenting hip dislocation?
Dr. Qureshi passionately believes in correcting all elements of the deformity as well as relocating the hip joint. His favoured approach for late presenting hip dislocation in walking-age children ,that does not respond to closed reduction, is single-stage hip reconstruction. Single-stage hip reconstruction is a comprehensive surgical procedure that addresses all elements of the deformity in late presenting hip dislocation. The key elements are
- Arthrogram (dye study) to outline the anatomy of the joint and determine whether a closed reduction is feasible.
- Open reduction procedure where the joint is opened to address the factors obstructing the hip from going back into the joint.
- Soft tissue balancing where muscles that are contracted are addressed through lengthening to ensure the hip joint is stable.
- Femoral osteotomy procedure where shortening of the thigh bone is done to help equalize leg lengths and the rotational alignment is also corrected to make the hip joint more stable.
- Pelvic osteotomy procedure, which is usually the most crucial element of maintaining a stable hip and minimising the risk of redislocation by dividing the pelvic bone to bring the socket down to improve coverage of the hip.
- Hip Spica cast, a plaster cast is applied from the upper abdomen down to the ankles leaving the nappy area relatively accessible for hygiene purposes.
What is the outcome following single-stage hip reconstruction?
Surgical outcomes for late-presenting hip dislocations are typically associated with the age of diagnosis, with less favorable results reported for older children in the literature. Dr. Qureshi employs a single-stage hip reconstruction technique, addressing all deformity elements comprehensively rather than solely focusing on hip relocation. Dr. Qureshi is pleased to showcase successful cases treated with this advanced approach.
According to the International Hip Dysplasia Institute, one in five hundred children is born with a dislocated hip. Although some will be diagnosed at birth, many will evade clinical detection and present when the child is walking age and a painless limp or asymmetry in the legs is noted. In children older than six months, an X-ray is a better investigation than an ultrasound to diagnose hip dysplasia.
If the hip is found to be dislocated on X-ray, a closed reduction under general anaesthetic with hip spica application can still be attempted. However, the chances of success reduce with the advancement of patient age.
The challenge with late presenting hip dislocation is often more than the fact that the ball of the hip joint is not in the socket. The other issues frequently encountered are:
- Barriers to the hip being relocated through manipulation: This is often due to structures being interposed between the ball and socket preventing its relocation.
- Deformity in the femur (thigh bone): Although the leg may be shorter, frequently the thigh bone overgrows and often may not point in the right direction.
- Deformity in the acetabulum (socket): In the absence of the favourable biomechanical influences of the normal hip joint, the empty socket fails to develop and remains shallow.
Dr. Qureshi passionately believes in correcting all elements of the deformity as well as relocating the hip joint. His favoured approach for late presenting hip dislocation in walking-age children ,that does not respond to closed reduction, is single-stage hip reconstruction. Single-stage hip reconstruction is a comprehensive surgical procedure that addresses all elements of the deformity in late presenting hip dislocation. The key elements are
- Arthrogram (dye study) to outline the anatomy of the joint and determine whether a closed reduction is feasible.
- Open reduction procedure where the joint is opened to address the factors obstructing the hip from going back into the joint.
- Soft tissue balancing where muscles that are contracted are addressed through lengthening to ensure the hip joint is stable.
- Femoral osteotomy procedure where shortening of the thigh bone is done to help equalize leg lengths and the rotational alignment is also corrected to make the hip joint more stable.
- Pelvic osteotomy procedure, which is usually the most crucial element of maintaining a stable hip and minimising the risk of redislocation by dividing the pelvic bone to bring the socket down to improve coverage of the hip.
- Hip Spica cast, a plaster cast is applied from the upper abdomen down to the ankles leaving the nappy area relatively accessible for hygiene purposes.
Surgical outcomes for late-presenting hip dislocations are typically associated with the age of diagnosis, with less favorable results reported for older children in the literature. Dr. Qureshi employs a single-stage hip reconstruction technique, addressing all deformity elements comprehensively rather than solely focusing on hip relocation. Dr. Qureshi is pleased to showcase successful cases treated with this advanced approach.
