Abstract
Objective:To document the clinical presentation of neglected DDH and evaluate the outcome of triple procedure.Methods:It was a descriptive case series study, conducted at the Department of Orthopedic Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad over a period of 8-years. It included children aged >1 and <9 years who underwent the triple procedure of open reduction, femoral shortening and Salter’s osteotomy. Clinical evaluation was performed using McKay’s criteria. Tonnis classification and Severin’s scoring system were employed for the radiological evaluation.Results:There were 193 children with 213 DDH affected hips. The mean age was 3.31±1.6 years. The preoperative severity of the femoral head dislocation per Tonnis classification was Grade-I in 7.98%(n=17), Grade-II in 48.35%(n=103) and Grade-III in 43.66%(n=93) hips. The postoperative MacKay criteria was ’Good’ to ’Excellent’ in 193(90.61%) hips. The postoperative Severin’s class was I in 113(53%) hips, II in 48(22.53%) hips, III in 43(20.18%) and IV in 9(4.22%) hips. The preoperative acetabular index ranged from 39° to 51° with a mean of 43.91±3.69°. The mean postoperative AI was 18.42±2.99°. The postoperative centre edge angle ranged from 21° to 26° with a mean 23.18 ±1.35°.Conclusions:The single stage triple procedure offers the surgical remedy of choice with favourable results for managing neglected and late diagnosed DDH among children aged 1-8 years.
Highlights
Developmental dysplasia of hip (DDH) represents a spectrum of anatomic hip abnormalities that affect the development and stability of the hip during the critical growth period
Theses abnormalities range from subtle acetabular dysplasia to the more sinister and complete subluxation or dislocation of the femoral head.[1,2,3]
Exclusion criteria were children
Summary
Developmental dysplasia of hip (DDH) represents a spectrum of anatomic hip abnormalities that affect the development and stability of the hip during the critical growth period. Theses abnormalities range from subtle acetabular dysplasia to the more sinister and complete subluxation or dislocation of the femoral head.[1,2,3] The incidence of DDH varies considerably in different parts of the world and range between 0.5% and 1.5%. The genetic factors are indicated by the increased incidence in female children and those with a positive family history. The goal of treatment is to achieve a stable concentric reduction without disrupting the critical circulation of femoral head and to maintain this reduction during childhood and adolescence. Reduction accelerates normal development of both the femoral head and acetabulum at the hip joint. In older children adequate reduction is a formidable foe when the femoral head is flattened or when the acetabulum is dysplastic. The present study was carried out to document the clinical presentation of neglected DDH and evaluate the outcome of triple procedure in terms of clinical and radiologic criteria
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