Abstract
Background: Delayed diagnosis and improper treated cases of developmental dysplasia of the hip (DDH) in the presence of excessive anteversion of femoral head may lead to undesirable consequences, including more extensive interventions with severe complications and functional disability. This study aimed to compare the clinical, radiological, and complication outcomes of simultaneously versus two-stage surgical procedures (open reduction and proximal femoral derotation osteotomy) in the treatment of DDH with excessive femoral anteversion among a sample of Iraqi children aged less than three years old. 
 Methods: A total of 26 DDH cases were treated in two groups (GI, GII) at Al-Wasity Teaching Hospital (Baghdad, Iraq) from January 2014 to March 2015. GI (15 hips) in 13 patients subjected to simultaneous open reduction (with/without salter osteotomy) and proximal femoral derotation osteotomy. GII (18 hips) in 13 patients operated in two stages procedure; open reduction (with/without salter osteotomy) followed by proximal femoral derotation osteotomy six weeks later. 
 Results: At the time of operation, the average age was 21.79±3.51months (range: 18-30). The mean follow-up period was 10.36 ±1.45 months (range, 8 -12). Statistically, the postoperative clinical, radiological, and complication findings were not significantly different between the two groups. However, in post-operative clinical assessment (McKay's criteria), the satisfying results (excellent and good) were 93% in GI and 88% in GII, respectively. Moreover, in radiological assessment (Severins classification), the satisfying results (excellent and good) were 94% in GI and 83% in GII, respectively. Two cases of re-dislocation and avascular necrosis (AVN) were reported in GII.
 Conclusion: When the clinical and radiological findings of one and two-stage open reduction and proximal femoral derotation osteotomy procedures are similar, the one-stage is more likely to overcome the two-stage in terms of minimizing the cost, length of stay and the risk of AVN of the femoral head.
Highlights
Delayed diagnosis and improper treated cases of developmental dysplasia of the hip (DDH) in the presence of excessive anteversion of femoral head may lead to undesirable consequences, including more extensive interventions with severe complications and functional disability
Delayed diagnosis and improper treated cases of developmental dysplasia of the hip (DDH) in the presence of excessive anteversion of femoral head may lead to undesirable consequences including the need for more extensive interventions with severe complications and functional disability which may negatively affect the quality of life of the patient [1,2]
The ultimate goal of treatment in DDH is to create an optimal condition for the normal growth of the acetabulum and the inside femoral head by achieving and maintaining concentric reduction [1,2,3]
Summary
Delayed diagnosis and improper treated cases of developmental dysplasia of the hip (DDH) in the presence of excessive anteversion of femoral head may lead to undesirable consequences, including more extensive interventions with severe complications and functional disability. Delayed diagnosis and improper treated cases of developmental dysplasia of the hip (DDH) in the presence of excessive anteversion of femoral head may lead to undesirable consequences including the need for more extensive interventions with severe complications and functional disability which may negatively affect the quality of life of the patient [1,2]. The ultimate goal of treatment in DDH is to create an optimal condition for the normal growth of the acetabulum and the inside femoral head by achieving and maintaining concentric reduction [1,2,3] This procedure is significantly related to the age of the patient at which the detection was made and the appropriate intervention [4]. Surgeons recommend closed reduction often to avoid the postoperative risk of reduced range of motion and AVN [8]
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