Abstract
Ali A Al-Iedan MBChB, CABS, Lecturer in Orthopaedics, Department of Surgery, College of Medicine, University of Basrah, Basrah – Iraq. Abstract The treatment of developmental dislocation of the hip (DDH) in older children is a challenge because they have high displacement of the hip, contracted soft tissues, insufficiency of the acetabulum and increased anteversion of the femoral head. In such patients it is difficult to reduce the femoral head into the acetabulum, maintain the concentric reduction and obtain a satisfactory functional hip joint. The aim of this study is to assess the advantage and disadvantage of one stage combined surgery with femoral shortening in treatment of DDH in children above 2 years old. This is a prospective study done in Al-Basrah General Hospital between (June 2008-June 2010), thirty patients were treated (35 hips), 28 females and 2 males. Five hips were right hip dislocation, 20 hips were left and 5 patients were bilateral. Femoral shortening done for all the hips and, in 28 hips pelvic osteotomy were performed at the time of open reduction. At the most recent follow-up (4 months-2 years) According to the radiographic criteria of Severin, 5 hips were excellent, 15 hips good and 10 hips have fair results, 5 end up hips had poor outcome. Avascular necrosis developed in 5 of the 35 hips. All patients were followed with respect to range of motion and recovery from limb-length discrepancy. Different complications were recorded per or postoperatively. Some complications like pelvic fracture (1 hip), subluxation and instability (3 hips), dislocation (2 hips) and stiffness (7 hips). According to the rating system of Mckay's clinical criteria, there were 7 hips excellent, 11 hips good, 12 hips fair results and 5 hips had a poor result. It is concluded that children who are two years or older and have DDH, can safely be treated with an extensive one-stage operation consisting of open reduction combined with femoral shortening and pelvic osteotomy, without increasing the risk of avascular necrosis. The limb length discrepancy that is produced by the shortening does not appear to cause a clinical problem.
Highlights
The treatment of developmental dislocation of the hip (DDH) is challenge in older children
An osteotomy of the proximal part of the femur to shorten the femur has been recommended to avoid the complication of avascular necrosis, this operation allows the tight structures that cross the level of the osteotomy to function as if they were lengthened and does so more effectively than a soft-tissue release
Radiograph of bilateral femurs were used to document any residual limb length discrepancy that might have resulted from iatrogenic femoral shortening
Summary
The treatment of DDH is challenge in older children. Those patients have high displacement of the hip, contracted soft tissues, insufficiency of the acetabulum and increased anteversion of the femoral head[1,2]. The problem lie in reducing the femoral head into the acetabulum maintaining the concentric reduction and obtaining a satisfactory functional hip joint[3]. Ombredanne[4] reported an operation that included open reduction with femoral shortening in 1932. Combined operation of open reduction with femoral shortening, iliac osteotomy and reorientation of the femoral head & neck, have been used since 1963. An osteotomy of the proximal part of the femur to shorten the femur has been recommended to avoid the complication of avascular necrosis, this operation allows the tight structures that cross the level of the osteotomy to function as if they were lengthened and does so more effectively than a soft-tissue release
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