Open reduction by means of a medial approach: an alternative for congenital hip dislocation

Abstract

Introduction Open reduction by means of a medial approach (adductors) is used in non-ambulating patients under 13 months, diagnosed with hip dislocation and managed with early closed reduction in unstable non concentric hips. Material and method The present retrospective study includes a series of cases that illustrate the authors’ experience. The results of 548 hips (367 patients) operated over a period of 12 years (1995-2007) are reported. Results Complications occurred in 62 hips. The most frequent were epiphysitis (2.9%), partial or total necrosis of the femoral head (6.3%) and redislocation (2%). Conclusions We describe a modification to the surgical technique originally reported by Ludloff, whereby the adductor brevis is not split; instead, the latter is detached and the pectineus muscle is pushed distally. In this way, the surgeon has a good view of the circumflex vessels, which protects them from injury. Also, the tension generated between the pectineus and the psoas by the abduction maneuvers is relaxed.