[Results of the treatment of hip joint dislocation by an over head traction and hanausek biomechanical device.].
The basic material for the evaluation of the results of a conservative treatment of DDH was a group of children at Ist Orthopaedic Clinic in the period of 1984-1994. In total 80 children were treated there, of this 69 girls and 11 boys. The right hip joint was affected 25times, the left hip joint 41 times, bilateral dislocation occured 14times.The evaluation covered in total 94 hip joints. In parents congenital dysplasia of hip joint occurred in case of 23 children, i. e. 28,5 %. The treatment followed immediately the diagnosis of the dislocation, on average at the age of 3.3 months of the child. All children were hospitalized with their mothers and over head traction was applied. Only in case of six children over head traction was not used and the children were immediately after the reduction placed in the Hanusek device. In the over head traction the lower limb was gradually abducted. The abduction should not exceed 70 degrees as it could result in the damage of vessels supplying the femoral head and the risk of ischemic necrosis is growing. Over head traction is considered a very gentle method of the reduction of the hip in the acetabulum of the hip joint. Contracted muscles are gradually released and the head is reduced by gradual abduction. The period of traction lasted between 2 to 8 weeks, on average 4 weeks. In our group we used over head traction for more than 6 weeks in five children. In three of them the hip could not be successfully reduced and open reduction was necessary. In one child there developed ischemic necrosis. After this period arthrography and open reduction is indicated. Over head traction is considered as a very successful method - in our group the conservative reduction of the hip joint failed only in 8 children, i. e. 10%. After the release of contractures and development of conditions for a stable position of the head in the acetabulum all children were further treated by the Hanausek biomechanical device. After the conservative treatment we have recorded ischemic necrosis in 7 children, i. e. in 7,4%. Ischemic necrosis was evaluated by Buchholz and Ogden. Type I has not been present,Type II and Type III occurred three times each and Type IV occured in one case. One of the conditions of a successful treatment by this device are detailed instructions provided to mothers on the method of the treatment and control of the child in the Hanausek device. With a proper treatment by this device the incidence of ischemic necrosis was lower than that described in literature. Key words: developmental dysplasia of the hip joint, Hanausek device.
Popelka
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I. ortopedická klinika 1. LF UK FN Motol, Praha.
Sosna
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