Abstract
OBJECTIVE: Cases of developmental dislocation of the hip (DDH) still occur after walking age because of late or missed diagnosis and failed conservative treatment. The choice of treatment for DDH after walking age continues to be controversial, and one of the options is open reduction combined with innominate osteotomy. METHODS: Twenty patients with 26 surgically treated hips with DDH, were evaluated from 2005 to 2008, using innominate osteotomy by Salter's technique after open reduction and capsulorraphy. The age of patients, fifteen females and five males, at time of surgery ranged from 12 to 18 months (mean age 14.7 months). Six patients had bilateral dislocation and in the remaining, nine had their left hip dislocated and five had their right hip dislocated. RESULTS: The results were evaluated according to modified McKay criteria and to Severin radiological criteria, after a mean follow-up of 46.7 months. Eighty - nine percent of hips were rated as excellent or good by McKay criteria. There were no poor results. According to Severin criteria, 77% were type I and II while 23% showed type III and IV, no hips were rated as Severin's group V or VI. There was one case (3.8%) of re-dislocation, but revision surgery resulted in stable, concentric, and permanent reduction. No cases of infection, graft fracture and vascular or nervous injury were reported. CONCLUSION: Open reduction combined with Salter osteotomy does not hurt the hip with regard to acetabular remodeling for children between 12 and 18 months of age. Level of Evidence IV, Case Series.
Highlights
Open reduction combined with Salter osteotomy does not hurt the hip with regard to acetabular remodeling for children between 12 and 18 months of age
Developmental dysplasia of the hip (DDH) involves several abnormalities ranging from simple hip instabilities with capsule looseness to complete dislocation of the femoral head relating to an abnormal acetabulum cavity.[1]
Mardam–Bey and MacEwen[5] found that 66% of children of walking age with developmental dysplasia of the hip who had undergone closed reduction required additional surgery, compared with 33% of such patients treated with open reduction
Summary
Developmental dysplasia of the hip (DDH) involves several abnormalities ranging from simple hip instabilities with capsule looseness to complete dislocation of the femoral head relating to an abnormal acetabulum cavity.[1] The inciting pathology is agreed to be abnormal laxity of the hip joint leading to subsequent displacement of the femoral head. Forceful traction and prolonged immobilization in forced abduction leads to AVN because of high intraarticular pressure.[7] This is the reason many authors recommend primary open reduction. Some authors recommend one–stage procedure consisting of open reduction, capsulorrhaphy, and innominate osteotomy. The osteotomy described by Salter in 1961, is an example of complete tran-
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