The Journal of Bone and Joint Surgery, Vol 73, Issue 3 410-423, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Growth disturbance of the proximal part of the femur after treatment for congenital dislocation of the hip
D Keret and GD MacEwen
Alfred I. duPont Institute, Wilmington, Delaware 19899.
The radiographs of ninety patients in whom treatment of unilateral
congenital dislocation of the hip was complicated by disturbance of growth
of the proximal part of the femur were studied retrospectively. All
patients were followed until closure of the affected proximal femoral
physis. We divided the patients into three groups, according to the degree
of vascular insufficiency: patients who had mild vascular insufficiency of
the hip, which had little effect on growth; those who had moderate vascular
insufficiency, which produces partial arrest of growth; and those who had
severe vascular insufficiency, which causes complete arrest of growth. Good
correlation was found between the initial degree of vascular insufficiency
and the radiographic results at the most recent follow-up. The radiographic
signs that were used to predict the extent of physeal involvement were a
crescent-shaped epiphysis, medial bowing of the femoral neck (a shorter and
more concave curve between the lesser trochanter and the proximal femoral
metaphysis [the lateral portion of the Shenton line]), lateral tilting of
the capital epiphysis, and premature physeal closure. Signs that were
diagnostic of existing physeal involvement were elevation of the greater
trochanter and shortening of the affected extremity. The presence and
severity of these signs correlated well with the degree of vascular
insufficiency. Medial bowing was the most reliable prognostic factor for
the determination of the fate of the hip joint at maturity.
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