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Abstract: The child was 9 years old and her parents found that she walked with a limp in her right lower limb. Initially, they thought that she had been injured accidentally, but after observing her for some time, her symptoms did not improve, so she was referred to our hospital.
Basic information】Female, 9 years old
Disease Type】Congenital dislocation of the right hip joint
Hospital】Shanxi Provincial People’s Hospital
Date of Consultation】May 2021
Treatment plan】Surgical treatment (right femoral subtrochanteric osteotomy + acetabular osteoplasty)
Treatment Period】10 days of inpatient treatment and regular outpatient follow up
Results】The alignment between the acetabulum and the femoral head was restored.
I. Initial consultation
A parent brought a little girl to the clinic. The parent said that the child walked with a limp and had pain when she moved. The child was asked to walk 20 meters back and forth, and the right lower limb was found to be different from the contralateral side. On examination, the right hip was found to be mildly flexed, shortened and externally rotated deformed, with positive local pressure pain. The right femoral head was poorly aligned with the acetabulum on orthopantomogram examination. The diagnosis was congenital hip dislocation on the right side, and the patient was admitted to the hospital.
II. Treatment process
After arranging hospitalization, in order to compare the length of both lower limbs, it was suggested that full-length orthopantomographies of both lower limbs be performed, and the child was recommended to undergo surgery to restore the congenital hip dislocation on the right side. The parents agreed, and the necessary blood tests were done, which were basically normal. On the third day, the child was scheduled for surgery and underwent osteotomy and acetabular osteoplasty of the right femoral ridge.
III. Treatment effect
On the second postoperative day, the child indicated that the pain symptoms were significantly reduced compared with the day of surgery, and the drainage flow from the wound drainage bag was also significantly reduced on the third postoperative day, so the drainage tube was removed. After the child’s condition stabilized, a right hip frontal and lateral radiograph was arranged again, which showed that the femoral head was well aligned with the acetabulum and the internal fixation was secure and in a satisfactory position. On the 10th day of hospitalization, the wound was dry, without redness, swelling and exudation, and there was no sign of infection, so the child was discharged.
Notes
We are glad that the child’s right congenital hip dislocation was treated with good results after surgery. Although the wound was closed intradermally, it required 2-3 days of wound care after discharge until 2 weeks after surgery, but there was no need to remove the stitches, and the child and parents were instructed to keep the wound dry for 1 month. The child and parents are instructed to keep the wound dry for 1 month. The child is also instructed to remember not to perform wound care at home to avoid infection. In addition, since the bone was osteotomized during the surgery and it takes 3 months for the bone to heal, the affected lower limb should not be put under weight for 3 months and should be reviewed regularly at the outpatient clinic after the surgery.
V. Personal insight
Congenital hip dislocation is not uncommon in clinical practice, either on one side or both sides. When parents find that their children have congenital hip dislocation, early treatment is recommended, as in the case of this child. For some reasons, only one side of the child was treated at that time. The treated side walked normally, but the affected side walked significantly differently, which had a negative impact on the child’s life. If congenital hip dislocation is left untreated for a long time, it may lead to osteoarthritis of the hip joint, causing long-term pain in the hip joint, at which point total hip replacement can only be performed.