Neglected, developmental hip dislocation treated with external iliofemoral distraction, open reduction, and pelvic osteotomy
ABSTRACT Between 1995 and 2003, we operated upon 18 children with 20 hips involved, aged 5-11 years (average: 7.5 years) suffering from an inveterate high developmental dislocation of the hip joint. An average follow-up period of our middle-term study was 51 months (range: 34-96 months). A two-staged management was applied. First, femoral head was lowered back to the level of acetabulum with an external fixator or a distractor device. The second stage involved open reduction combined with pelvic osteotomy and, in four cases with femoral derotation osteotomy. We noted two cases of avascular necrosis. Equal limb length was achieved in 15 cases. There were two cases of 0.5-cm length discrepancy, two cases of 1-cm length inequalities, and one case of 5-cm limb shortening. We endorse this method in neglected cases of previously untreated unilateral high developmental hip dislocations in children aged 8-10 years. It results in a usable hip joint without the need of femoral shaft shortening and facilitates future joint replacement.
Journal of orthopaedic surgery (Hong Kong) 07/2004; 12(1):1-3.
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ABSTRACT: In untreated developmental dysplasia of the hip (DDH), degenerative changes of the femoral heads develop mainly in hips with pseudoacetabular formation. But degenerative changes may also occur due to friction between the femoral heads and surrounding soft tissues after prolonged walking. The purpose of this study was to investigate the relationship between anatomic classifications of DDH and clinical manifestations. Twenty five consecutive patients with untreated DDH who underwent open reduction and reconstructive surgery between 1982 and 2001 were included in this retrospective analysis. All of the patients were female and had unilateral dislocation. The age of the patients ranged from 12 to 28 years (median, 17 years). The relationships among preoperative and postoperative radiographs, and between clinical symptoms, and gross pathology at surgery were analyzed. Based on the height of dislocation and pseudoacetabular formations on plain radiographs, 3 types of dislocations were recognized: 1) low dislocation with pseudoacetabular formation in 6 hips; 2) high dislocation with definite pseudoacetabular formation in 4 hips; and 3) high dislocation without definite pseudoacetabular formation in 15 hips. The incidence of pain, dystrophic radiographic change of the femoral head and the presence of degenerative change at the time of surgery were significantly greater in hips with high dislocation and pseudoacetabular formation and patients with high dislocation without pseudoacetabulum formation (p < 0.05). Degenerative change of the femoral heads can develop in untreated dislocated hips of patients with skeletally mature DDH regardless the height of dislocation and pseudoacetabular formation.Journal of the Formosan Medical Association 06/2005; 104(5):349-53. · 1.70 Impact Factor
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ABSTRACT: When conservative treatment of developmental hip dysplasia (DDH) does not render satisfactory results, surgical methods are indicated to gain a maximum of joint posture and stability. To assess the efficiency of these surgical procedures, the long-term results of the most often used pelvic osteotomies were examined. As common evaluation scores do not apply for DDH, we developed a specific score system of 100 points to integrate subjective factors such as patient's complaints with objective functional and radiological findings after surgical intervention. Our survey with an average postoperative follow-up examination of 10 years indicated that Salter's innominate osteotomy can render long-term pain relief and enable normal hip development, whereas Chiari's capsular arthroplasty does not. Here, subjective patient complaints do not correlate with clinical and radiological findings, which leads to unsatisfactory results. Ideally, patients aged 2-3 years can undergo Salter's innominate osteotomy whereas the Chiari osteotomy should be considered for patients older than 15 years. Even under optimal surgical conditions, Chiari's osteotomy cannot significantly prevent the development of joint arthritis. Undoubtedly, late results of both surgical procedures are dependent upon the initial stage of DDH. Additional upper femoral correction osteotomies have no further influence on hip development.Archives of Orthopaedic and Trauma Surgery 02/1998; 117(4-5):222-7. DOI:10.1007/s004020050233 · 1.31 Impact Factor