[Irreductible congenital dislocation of the hip at birth].

BACKGROUND

Rare congenital dislocation of hip (CDH) (0.03 for 1,000 births) are irreducible at birth; they are named teratologic in literature. However some of them are isolated without any pathological context, having a postural origin or due to an underlying disease.

PATIENTS: Seventeen dislocated hips, irreducible at birth, were seen in 12 infants and included in this study. Clinical examination of these neonates was normal with the exception of signs of CDH. Postural abnormalities such as pes calcaneus, genu recurvatum, torticolis were seen in ten infants but none of the 12 had any manifestation of neurologic, dystrophic or malformative disease. However, manifestations of a disease able to explain the CDH such as congenital myopathy, cutis laxa, cortical atrophy, Klinefelter syndrome, appeared within the following months in four infants. Treatment of these CDH started in every case by an attempt of reduction by continuous traction and was efficient in eight cases. A redislocation occurred for four hips and this treatment was uneffective for five hips. Finally seven hips had to be treated by open reduction. Reduction was maintained for nine hips after closed treatment (one of them after a redislocation and a second time of orthopaedic treatment). One hip is still dislocated after failure of closed treatment. Stabilisation of the reduction was necessary by pelvic and/or femoral osteotomy in majority of cases.

CONCLUSIONS

Morphological modifications of hip established from X-rays and during the surgical procedure are rather related to the age of the dislocation making inappropriate the term "teratologic". The irreducible and isolated CDH can be postural in origin but as well due to a disease whom manifestations will appear lately. Their treatment, orthopaedic or surgical, is difficult and the results often disappointing.