Congenital Dysplasia and Dislocation of the Hip in Children and Adults by Dietrich Toennis, Terry C. Telger, Helmut Legal , Springer

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Springer Congenital Dysplasia and Dislocation of the Hip in Children and Adults by Dietrich Toennis, Terry C. Telger, Helmut Legal

For more than 100 years, congenital dislocation of the hip has been an area of concern in orthopedics. This publications on the subject are al most too numerous to count. Yet our knowledge of the basic principles of congenital hip dislocation and its management is constantly being expanded by new research. In Germanspeaking countries, Kaiser pub lished the last comprehensive textbook on congenital hip dislocation in 1958, and Schlegel followed with a comprehensive handbook in 1961. In the Angloamerican world, Coleman's monograph was pub lished in 1978, Somerville's in 1982, and Wilkinson's in 1985. In 1982 Tachdjian compiled a volume on congenital hip dislocation that con tained contributions from 44 authorities. The purpose of the present book is to provide an overview of our pre sent state of knowledge of congenital hip dislocation, covering basic principles, diagnosis, methods of closed and open treatment, and indi cations. In the process, an attempt is made to trace progress in the field from its beginnings to the present time. Many authors describe the diagnosis and treatment of congenital hip dysplasia and dislocation in terms of specific age groups. We believe it is more prudent to take an individualized approach based on arthro graphic findings and the degree of severity of pathologic changes. Less emphasis is placed here on the management of patients by age group._x000D_ Table of contents : - _x000D_ 1 Anatomic Aspects.- 1.1 Anatomy of the Hip Joint.- 1.1.1 The Acetabulum.- 1.1.2 Position of the Acetabulum.- 1.1.3 The Femoral Head.- 1.1.4 The Femoral Neck.- 1.1.5 Angle of Femoral Torsion.- 1.1.6 Femoral Shaft Axis, Mechanical Axis, and Knee Joint Axis.- 1.1.7 Tibial Torsion.- 1.1.8 The Role of the Acetabular Labrum and Atmospheric Pressure in Stabilizing the Hip.- 1.1.9 The Capsule and Ligaments of the Hip.- 1.1.10 The Muscles of the Hip.- 1.2 Vascular Supply of the Hip.- 1.2.1 Vascular Supply of the Femoral Head and Femoral Neck.- 1.2.2 Vascular Supply of the Acetabulum.- 1.3 Innervation of the Hip Joint.- 2 Development of the Hip Joint.- 2.1 Development of the Acetabulum.- 2.2 Principles of Pelvic Growth.- 2.2.1 External Apposition (Perichondrial and Periosteal).- 2.2.2 Internal, Proportional Resorption in the Pelvic Aperture.- 2.2.3 Chondral Growth Principle.- 2.2.4 Details of Growth.- 2.3 Development of the Proximal Femur.- 2.4 Factors Influencing the Growth and Shape of the Proximal Femur.- 2.4.1 Static Forces.- 2.4.2 Muscular Forces.- 2.5 Shape and Position of the Hip Joint During Development.- 2.6 Growth of the Juvenile Hip Joint as Established from Planimetric Measurements.- 3 Development of the Vascular System of the Hip Joint and Its Variations with Reference to Ischemia.- 3.1 Vascular Pattern at Birth.- 3.2 Infantile Phase (from About Four Months to Four Years).- 3.3 Intermediate Phase from About Four to Seven Years.- 3.4 Preadolescent Phase from 9 to 10 Years.- 3.5 Adolescent Phase.- 3.6 Variations of the Vascular Pattern.- 3.7 Clinical Implications.- 4 Introduction to the Biomechanics of the Hip.- 4.1 General.- 4.2 Loads and Stresses on the Hip.- 4.3 Current Knowledge on the Biomechanics of the Hip (Literature Survey).- 4.4 Anatomic Aspects.- 4.5 Radiographic Aspects.- 4.6 Principles of Biomechanical Analysis.- 4.7 The Load on the Hip.- 4.7.1 Load Model.- 4.7.2 Discussion of Geometric Parameters Used to Determine the Hip Load.- 4.7.3 Procedure for Calculating the Hip Load.- 4.7.4 Remarks on Load Calculations.- 4.8 The Stress on the Hip.- 4.8.1 Model for Calculating Joint Pressure (Maximum Pressure, Equal Pressure Distribution).- 4.8.2 Correction of the Pressure Calculation (Position of the Femoral Head Center C, Acetabular Anteversion).- 4.8.3 Calculation of Weight-Bearing Area with Allowance for the "Mean Inlet Plane".- 4.8.4 Pressure Distribution (Linear Pressure Rise, Hooke's Law).- 4.9 Explicit Calculation of Load and Stress.- 4.9.1 The Normal Hip.- 4.9.2 Illustrative Case.- 4.9.3 Published Reports on Biomechanical Data in the Normal Hip.- 4.10 Standard Treatments of Hip Dysplasia in Adults and Their Biomechanical Efficacy.- 4.10.1 Intertrochanteric Osteotomies.- 4.10.2 Trochanteric Transfer.- 4.10.3 Pelvic Operations.- 4.11 Questions Relating to the Planning of Operative Tactics.- 4.12 Conclusion.- 5 Etiology of Congenital Dislocation of the Hip.- 5.1 Older Causation Theories.- 5.2 Anatomic and Racial Predisposition.- 5.3 Prevalence and Geographic Distribution.- 5.4 Sex Incidence and Ratio of Affected Sides.- 5.5 Inheritance.- 5.6 Exogenous, Mechanical Causative Factors.- 5.7 The Study of P. M.Dunn.- 5.8 Further Studies on Mechanical Causative Factors.- 5.9 Hormonal Effects on the Hip Capsule.- 5.10 Capsular and Ligament Laxity.- 5.11 Seasonal Influences.- 5.12 Summary and Conclusion.- 6 Pathologic Anatomy of Congenital Dislocation of the Hip.- 6.1 Grade 1 Dislocation of the Hip.- 6.2 Grade 2 Dislocation of the Hip.- 6.3 Grade 3 Dislocation of the Hip.- 6.4 Direction of Dislocation and Orientation of the Acetabulum.- 6.5 The Proximal Femur.- 6.5.1 Coxa Valga.- 6.5.2 Femoral Antetorsion.- 6.5.3 The Femoral Head.- 6.6 Vascular Supply in High Dislocations.- 6.7 The Muscles in Congential Dislocation of the Hip.- 7 Nomenclature and Classification of Congenital Hip Dislocation.- 7.1 Nomenclature.- 7.2 Classification of Congenital Hip Dislocation and Anatomic Findings.- 7.3 Grades of Dislocation According to Howorth and Dunn.- 7.4 Grades of Dislocation According to the CSHD.- 7.5 Graf's Classification by Sonographic Appearance.- 8 Clinical Examination of the Hip.- 8.1 History.- 8.1.1 Newborns and Infants.- 8.1.2 Older Children and Adults.- 8.2 Examination During Walking and Standing.- 8.2.1 Limp with a Positive Trendelenburg Sign.- 8.2.2 Limp Due to Shortening.- 8.2.3 Limp Due to Pain.- 8.2.4 Limp Due to Ankylosis.- 8.2.5 Examination in Stance.- 8.3 Testing the Range of Hip Motion in Older Children and Adults.- 8.3.1 Flexion and Extension.- 8.3.2 Abduction and Adduction.- 8.3.3 Internal and External Rotation.- 8.4 Testing the Range of Hip Motion in Newborns.- 8.5 Limitations of Hip Motion in Congenital Hip Dysplasia and Dislocation.- 8.6 Further Tests for Exclusion of Hip Dysplasia and Dislocation in Infants.- 8.6.1 Leg Length Examination in Infants.- 8.6.2 Skin Relief and Skin Folds.- 8.6.3 Manual Examination of the Hip.- 8.6.4 Expanded Classification of Palpatory Findings.- 8.6.5 Techniques of Manual Examination.- a) Ortolani's Examination.- b) Examination of Coleman and Palmen.- c) Barlow's Examination.- d) Dislocation and Reduction Sign of Klopfer.- e) Our Examination Technique.- 8.7 Anatomic Basis of the Roser-Ortolani Sign.- 8.8 DryHipClick.- 8.9 Naming the Roser-Ortolani Sign.- 8.10 Definition of the Roser-Ortolani Sign.- 8.11 Ludloff's Sign.- 9 General Radiography of the Hip Joint.- 9.1 Radiographic Evaluation of the Acetabulum.- 9.1.1 AP Pelvic Film for Evaluating the Lateral Acetabular Roof.- 9.1.2 Faux Profil View for Demonstrating the Anterior Acetabular Roof.- 9.1.3 View of Chassard and Lapine for Evaluating the Posterior Acetabular Rim and Acetabular Anteversion.- 9.1.4 View of Dunlap et al. for Evaluating the Posterior Acetabular Rim and Acetabular Anteversion.- 9.2 Radiographic Evaluation of the Femoral Neck.- 9.2.1 Frontal (Anteroposterior) View.- 9.2.2 Lateral Views of the Femoral Neck.- a) Axial Hip Views of Dunn, Rippstein and Muller for Evaluating Femoral Antetorsion.- b) Axial Orthograde View of the Hip for Evaluating the Second Plane of the Femoral Head and Neck.- c) Axial Views of the Hip in the Vertical Projection (Lauenstein's View) and in the Horizontal Projection (Sven Johansson's View).- 9.3 Functional Views of the Hip Joint.- 9.3.1 View of Andren and von Rosen for the Diagnosis of Hip Dislocation.- 9.3.2 Abduction-Medial Rotation View (Lange's Position) in Small Children.- 9.3.3 Functional Views in Older Children and Adults.- 9.4 Commonly Used Reference Lines for the Diagnosis of Hip Dislocation in Newborns and Infants.- 9.4.1 Hilgenreiner's Line.- 9.4.2 Line of Ombredanne and Perkins.- 9.4.3 The Epiphyseal Triangle of Mittelmeier for Evaluating the Position of the Capital Femoral Ossification Center.- 9.4.4 Linear Measurements of Trochanteric Height and Femoral Displacement.- 9.4.5 Orienting Line of Shenton and Menard.- 9.4.6 Orienting Line of Calve.- 9.4.7 Parallelogram of Kopits.- 9.4.8 Measurements for Diagnosing Hip Instability in Children and Adolescents.- 9.5 Radiographic Indicators of Correct Positioning.- 9.5.1 Quotient of Pelvic Rotation (Toennis and Brunken).- 9.5.2 AP Pelvic Tilt (Toennis and Brunken).- 9.5.3 Pelvic Tilt Index (Ball and Kommenda).- 9.5.4 Neutral Position of the Femoral Neck.- 9.6 Radiographic Indicators of Hip Dysplasia.- 9.6.1 Acetabular Inlet Plane.- a) Measuring the Transverse Acetabular Inclination (After Ullmann, Sharp, Stulberg and Harris).- b) Anteversion of the Acetabular Inlet Plane (as Measured by the Radiographic Projection of Chassard and Lapine and CT).- 9.6.2 The Acetabular Index.- a) Acetabular Index of Hilgenreiner (AC Angle).- b) Acetabular Index of the Weight-Bearing Zone in Adolescents and Adults.- c) ACM Angle of Idelberger and Frank.- 9.6.3 Angles Which Evaluate the Femoral Head-Acetabular Relationship.- a) Lateral Coverage: the Center-Edge (CE) Angle of Wiberg.- b) Anterior Coverage: VCA Angle of Lequesne and de Seze.- c) Entry Angle of von Lanz.- d) Composite Evaluation of the Hip Joint (the "Hip Value").- 9.6.4 Angular Measurements of the Femoral Neck.- a) The Neck-Shaft Angle (CCD Angle = Centrum-Collum-Diaphyseal Angle of M. E. Muller).- b) The Antetorsion Angle (AT Angle) of Dunn-Rippstein-Muller.- 9.7 Angle Changes Caused by Positioning Errors.- 9.7.1 The AP Pelvic View.- 9.7.2 The Antetorsion View.- 9.8 Normal Values of the Neck-Shaft Angle and Antetorsion.- 9.8.1 CCD Angle.- 9.8.2 AT Angle.- 9.9 Historical Development of Torsion Determination.- 9.9.1 Determination of Antetorsion from the Angle of Medial Rotation.- 9.9.2 Determination ofthe AT Angle on Lateral Radiographs.- 9.9.3 Determination ofthe AT Angle in Abduction.- 9.9.4 Determination ofthe AT Angle on Orthograde Films.- 9.9.5 Determination of Torsion Using the Projected Neck-Shaft Angle and Projected AT Angle in Abduction.- 9.9.6 Other New Techniques.- 9.10 Angle of the Capital Femoral Epiphysis.- 9.10.1 Defining the Epiphyseal Line.- 9.10.2 Epiphysis-Triradiate Cartilage Angle (EY Angle) of Cramer and Haike.- 9.10.3 Epiphysis-Femoral Neck Angle (KE Angle) of Jager and Refior.- 9.10.4 Epiphysis-Shaft Angle of Jones and Immenkamp.- 9.10.5 Malprojection Caused by Antetorsion and Lateral Rotation.- 9.11 Indices and Quotients for Evaluations of the Hip Joint.- 9.11.1 Definition.- 9.11.2 Various Indices and Quotients.- 10 Arthrography of the Hip Joint.- 10.1 Importance of Arthrography.- 10.2 History of Arthrography.- 10.3 Technique of Hip Arthrography.- 10.3.1 Selecting a Contrast Medium.- 10.3.2 Approaches for Arthrography of the Hip.- 10.4 The Question of Harmful Effects.- 10.5 Arthrographic Features of the Normal Hip.- 10.6 Arthrographic Features of the Abnormal Hip.- 10.7 Classification Systems and Therapeutic Guidelines of Various Authors Based on Arthrographic Findings.- 10.7.1 Classification of Leveuf and Bertrand.- 10.7.2 Classifications of Howorth, Mitchell, Doerr, and P.M.Dunn.- 10.7.3 Grades of Dislocation According to Guilleminet et al.- 10.7.4 Other Classifications.- 10.7.5 Arthrographic Classification of Acetabular Dysplasia Unaccompanied by Dislocation.- 10.7.6 Classification of Schwetlick.- 10.7.7 Peic's Classification of Labrum Morphology.- 10.7.8 Arthrographic Grades of Dislocation According to Toennis.- 10.7.9 Arthrographic Grades of Reduction (Toennis).- 10.8 Evaluation of Treatment Options Based on Arthrograms.- 11 Computed Tomography of the Hip Joint.- 11.1 General.- 11.2 Prerequisites.- 11.3 Positioning.- 11.4 The Diagnostic Value of Pelvic CT.- 11.5 Indication.- 11.6 Illustrative Cases.- 12 Radiation Exposure and Radiation Protection.- 12.1 Effect of Radiation.- 12.2 Radiation Exposure and Genetically Significant Dose.- 12.3 Radiation Protection.- 13 Clinical and Radiographic Schemes for Evaluating Therapeutic Results.- 13.1 Problems of Hip Evaluation.- 13.2 Evaluation Scheme Based on Grades of Deviation from Normal.- 13.2.1 Clinical Findings.- a) Limitation of Motion.- b) Trendelenburg's Sign.- c) Pain.- 13.2.2 Radiographic Findings.- a) General Criteria.- b) Classification of Radiographic Indicators by Their Degree of Deviation from Normal.- 14 The Ultrasound Examination of the Hip.- 14.1 Technical Principles.- 14.1.1 Basic Physical Concepts.- 14.1.2 The Production of Ultrasound Waves.- 14.1.3 Physical Phenomena That Are Important in Sonography.- 14.1.4 Techniques for Producing an Ultrasound Image.- 14.1.5 Artifacts.- 14.1.6 Real-Time Scanners.- 14.2 Physical Effects, Biologic Effects, and Questions of Safety.- 14.2.1 Physical Effects.- 14.2.2 Biologic Effects.- 14.3 Ultrasound Instruments for Orthopedic Applications.- 14.3.1 Basic Requirements of the Ultrasound Instrument for Use in the Infant Hip.- 14.3.2 Linear or Sector Scanner.- 14.3.3 Adjusting the Ultrasound Instrument.- 14.3.4 Instrument Adjustments for Hip Sonography.- 14.4 Image Documentation and Recording Systems.- 14.4.1 Basic Requirements for the Documentation of Hip Sonograms.- 14.4.2 Recording Systems.- 14.5 Anatomic Aspects of Hip Sonography.- 14.5.1 Beam Direction and the Soft-Tissue Envelope.- 14.5.2 The Femoral Neck, the Femoral Head, and the Capital Femoral Ossification Center.- 14.5.3 The Acetabulum: Anatomic Aspects and Questions of Nomenclature.- 14.5.4 The Sonographic Appearance of the Acetabular Roof and Perichondrium.- 14.5.5 The Topographic Relationships of the Labrum, the Perichondrial Hole, and the Proximal Third of the Perichondrium.- 14.5.6 The Standard Situation.- 14.5.7 The Fluid Film.- 14.5.8 The Echogenicity of the Acetabular Fossa.- 14.6 The Standard Plane, Measuring Technique, and Errors of Measurement.- 14.6.1 The Problem of the Standard Plane.- 14.6.2 Conclusion and Definition of the Standard Plane.- 14.6.3 Measuring Technique and Errors of Measurement.- 14.7 Grades of Dislocation on Sonograms (Sonographic Hip Types).- 14.7.1 Description of Findings.- 14.7.2 Type 1 Hip.- 14.7.3 Type 2 Hip.- 14.7.4 Type 3 a und 3 b Hip.- 14.7.5 Type 4 Hip.- 14.7.6 Evaluating the Structure of the Roof Cartilage.- 14.8 Sonographic Assessments of Hip Maturity with the Sonometer.- 14.8.1 The Sonometer.- 14.8.2 The Fine Differentiation of Hip Types.- 14.8.3 Significance of the ?- and ?- Angles.- 14.9 Positioning and Scanning Technique.- 14.9.1 Principle.- 14.9.2 The Positioning Apparatus.- 14.9.3 Scanning Technique.- 14.9.4 The Dynamic Examination.- 14.10 Sonographic Follow-Ups, and Comparisons of Sonography, Radiography, and Arthrography.- 14.10.1 Sonograms of Normal Hips at Various Age Levels.- 14.10.2 Individual Sonograms of Type 2a Through 2c Hips.- 14.10.3 Monitoring the Response of Type 2b-2d Hips to Therapy.- 14.10.4 Comparisons of Sonograms and Radiographs.- 14.10.5 Sonographic Monitoring of Therapeutic Response.- 15 Diagnosis of Congenital Dysplasia and Dislocation of the Hip and Indications for Therapeutic Measures.- 15.1 Early Diagnosis and Indications for Therapeutic Measures.- 15.5.1 General.- 15.1.2 Findings on Clinical Examination.- 15.1.3 Absolute and Relative Indications for Sonography and Radiography.- 15.1.4 Sonographic Diagnosis and Indications for Treatment.- 15.1.5 Radiography of the Infant Hip and Its Role in Diagnosis and Management.- 15.2 Late Diagnosis.- 16 The Conservative Treatment of Congenital Dysplasia and Dislocation of the Hip.- 16.1 Treatment of Hip Dysplasia.- 16.2 Treatment of the Dislocated Hip.- 16.2.1 Reduction of the Dislocated Hip.- 16.2.2 Resolution of Instability (Stabilization Phase).- 16.2.3 Resolution of Residual Dysplasia.- 16.2.4 Complications of Closed Reductions.- 17 Technique of the Conservative Treatment of Hip Dysplasia and Dislocation.- 17.1 Manual Reduction Methods.- 17.1.1 The Lorenz Technique of Manual Reduction.- 17.1.2 The Lange Technique of Manual Reduction.- 17.2 Methods of Immobilizing Unstable and Dysplastic Hips.- 17.2.1 The von Rosen Splint.- 17.2.2 The Abduction Pillows of Becker and Mittelmeier.- 17.2.3 Abduction Splints.- 17.3 Harnesses for Reducing the Dislocated Hip.- 17.3.1 The Pavlik Harness.- 17.3.2 The Hoffmann-Daimler Harness.- 17.4 Traction in the Treatment of Congenital Hip Dislocation.- 17.4.1 Longitudinal Traction.- 17.4.2 Traction in Abduction and Medial Rotation.- 17.4.3 Overhead Traction.- 17.4.4 The Kramer Method of Hip Reduction by Traction.- 17.5 Reduction of the Hip in the Hanausek Apparatus.- 17.6 The Fettweis "Squatting Position" of Cast Immobilization.- 17.7 Hip Reduction Under Arthrographic Control (Our Technique).- 18 Ischemic Necrosis of the Femoral Head in the Treatment of Congenital Hip Dislocation.- 18.1 Causes of Ischemic Necrosis Complicating the Treatment of Congenital Hip Dislocation.- 18.1.1 Summary and Conclusion.- 18.2 Nomenclature and Classification of Ischemic Necrosis.- 18.3 Studies on the Dependence of Ischemic Necrosis on Treatment Method, Position of Immobilization, Length of Immobilization, Grade of Dislocation, and Age.- 18.4 Studies on the Dependence of Ischemic Necrosis on Arthrographic Findings.- 18.4.1 Discussion of Results.- 19 On the History of the Treatment of Congenital Hip Dislocation.- 20 Published Results on the Early Diagnosis and Treatment of Congenital Hip Dislocation.- 20.1 Frequency of Palpable Signs in Newborns.- 20.2 Adduction Contracture in Newborns.- 20.3 Detection of Congenital Hip Dislocation and Results of Treatment.- 20.4 Ischemic Necrosis of the Femoral Head Complicating Neonatal Treatment.- 20.5 On the Pathologic Significance of Neonatal Hip Instability with and Without the Roser-Ortolani Sign and "Dry Hip Click".- 20.6 Dysplasia and Dislocation in Hips That Are Clinically Stable at Birth.- 20.7 Factors Which Promote or Inhibit the Development of Hip Dysplasia.- 21 Reports on the Results of the Closed Treatment of Congenital Hip Dislocation at Different Ages Using Various Methods.- 21.1 Overview of Results.- 21.2 Ischemic Necrosis of the Femoral Head.- 21.3 Age at Start of Treatment.- 21.4 Initial Status: Dysplasia, Subluxation, Dislocation, and Acetabular Index.- 21.5 Duration of Treatment and Follow-Up.- 21.6 Concentric Reduction, Normal Function, Surgical Intervention.- 21.7 Dependence of Joint Parameters on One Another and on the Immobilized Position of the Femur.- 21.8 Our Own Treatment Results, Classified According to the Scheme of the CSHD.- 22 Technique of Open Reduction of the Congenitally Dislocated Hip.- 22.1 Obstacles to Reduction.- 22.2 Approaches for Open Reduction of the Hip.- 22.2.1 The Medial Approach of Ludloff.- 22.2.2 The Anterior Approach.- a) Longitudinal Incision.- b) Inguinal Incision.- c) Our Technique.- 22.2.3 The Anterolateral Approach.- 22.2.4 The Lateral Approach.- 22.2.5 The Posterior Approach.- 22.3 Open Reduction of the Hip in the First Six Months of Life.- 22.4 Open Reduction of the Hip up to Three Years of Age.- 22.4.1 Ischemic Necrosis.- 22.4.2 Postoperative Adhesions, Limitations of Motion, Stiffness.- 22.4.3 Redislocation.- 22.4.4 Operative Technique.- 22.5 Open Reduction of the High, Longstanding Hip Dislocation.- 22.5.1 Preliminary Traction.- 22.5.2 Traction After Prior Release of Muscles and Soft Tissues.- 22.5.3 Femoral Shortening as a Preliminary to Hip Reduction.- 22.5.4 Arthroplasty of Codivilla and Colonna.- 22.5.5 Our Technique.- 23 Review of the Literature on Open Reduction of the Hip.- 23.1 General Overview.- 23.2 Indications.- 23.3 Operative Technique in Small Children.- 23.4 Results of Open Reductions in Small Children.- 23.5 Hip Reductions in Older Children.- 23.6 Current Indications for Late Open Reduction of the Hip.- 24 Femoral Osteotomies to Improve the Hip Joint.- 24.1 Classification of Femoral Osteotomies.- 24.2 Technique of the Intertrochanteric Derotation Varus Osteotomy in Children.- 24.2.1 Preoperative Preparations.- 24.2.2 Exposure of the Operative Site.- 24.2.3 Intertrochanteric Osteotomy.- 24.2.4 Techniques of Wedge Resection for Varus Osteotomy.- 24.2.5 Amount of Varus Angulation and Derotation.- 24.2.6 Amount of Medialization in Varus Osteotomy.- 24.2.7 Fixation ofthe Osteotomy.- 24.2.8 Details of the Conduct of the Operation and Aftertreatment.- 24.3 Valgus Osteotomy in Children.- 24.4 Intertrochanteric Osteotomies in Adolscents and Adults.- 24.4.1 Prophylactic Osteotomies.- 24.4.2 Osteotomies in the Presence of Osteoarthritis.- 24.4.3 Internal Fixation of Intertrochanteric Osteotomies in Adolescents and Adults.- 24.5 Subtrochanteric Osteotomy at Various Age Levels.- 24.6 Shortening Osteotomy in Open Reductions of the Hip.- 24.7 Inter- and Subtrochanteric Step-Cut Shortening Osteotomy.- 24.8 Angulation Osteotomy (Buttress Osteotomy, Pelvic Support Osteotomy).- 24.9 Resection-Angulation Osteotomy.- 24.10 Transfer of the Greater Trochanter.- 24.11 Valgus Osteotomy for Extreme Coxa Vara (Intertrochanteric Double Osteotomy with Trochanteric Transfer).- 25 Pelvic Operations for Dysplasia of the Hip.- 25.1 Shelf Operations.- 25.2 Acetabuloplasties.- 25.2.1 Lateral Approach.- a) Location of the Hinge for Various Acetabuloplasties.- b) Age and Prerequisites.- c) Our Technique of Acetabuloplasty.- 25.2.2 Anterior Approach.- 25.3 Pelvic Osteotomies That Redirect the Acetabulum.- 25.3.1 Salter's Single Innominate Osteotomy.- 25.3.2 Double and Triple Osteotomies with Acetabular Rotation.- a) Double Osteotomy of LeCoeur.- b) Double Osteotomy of Sutherland and Greenfield.- c) Double and Triple Osteotomy of Hopf.- d) Triple Osteotomy of Steel.- e) Triple Osteotomy of Toennis.- 25.3.3 Spherical Osteotomies.- a) Spherical Osteotomy of Blavier and Blavier and Wagner.- b) The Dial Osteotomy.- 25.4 Chiari's Medial Displacement Osteotomy.- 26 Total Hip Arthroplasty for the Treatment of Hip Dysplasia with Osteoarthritis.- 27 Survey of the Literature on the Surgical Management of Hip Dysplasia and Femoral Neck Deformities.- 27.1 Shelf Operation and Acetabuloplasty.- 27.2 Correction of Antetorsion.- 27.3 Corrective Osteotomies of the Femoral Neck.- 27.4 Correction of Valgus and Antetorsion.- 27.5 Operations on the Acetabular Roof and Pelvis.- 27.6 Should Pelvic Operations Be Combined with Femoral Osteotomy?.- 27.7 Age Limits of Various Procedures.- 27.8 Acetabular Rotation.- 27.9 Comparative Studies on the Capabilities of Various Operative Methods and the Postoperative Behavior of the Joint.- 27.9.1 Collective Statistics of the CSHD on the Results of Operative Treatment in Children.- 27.9.2 Conclusions.- 28 On the Indications for Operative and Nonoperative Treatment Measures in Hip Dysplasia.- 28.1 General.- 28.2 Principles of Decision-Making During Growth.- 28.3 Principles of Decision-Making After the Cessation of Growth.- 28.4 Other Factors Affecting the Choice of Treatment.- 28.5 Summary and Conclusions.- 29 Clinical Examples of Indications for Operative and Nonoperative Treatment Measures, and the Management of Complications.- 29.1 General.- 29.2 Examples of Radiograph Interpretation in Infants and Small Children.- 29.3 Special Problems in Hip Reductions.- 29.4 Problems of Further Management After Hip Reduction: The Unstable Hip.- 29.5 Management of Coxa Magna.- 29.6 Varus Osteotomy Alone or Only in Conjunction with Acetabuloplasty?.- 29.7 Spontaneous Development of the Hip.- 29.7.1 Examples of Hip Dysplasia with Excessive Antetorsion.- 29.7.2 Toeing-In Syndrome (Antetorsion Syndrome).- 29.7.3 Retrotorsion.- 29.7.4 Spontaneous Development of the Dysplastic Hip.- 29.8 The Radiographic Features of Hip Dysplasia in Adolescents and Adults.- 29.9 Methods for the Operative Treatment of Hip Dysplasia in Adults.- 29.10 Techniques to Handle Complications.- 29.11 On the Indication of Surgery After Ischemic Necrosis.- 30 Literatur.- 31 Subject Index._x000D_ show more