Is concomitant bone surgery necessary at the time of open reduction in developmental dislocation of the hip in children 12-18 months old? Comparison of open reduction in patients younger than 12 months old and those 12-18 months old.
ABSTRACT It is controversial to perform bone surgery at the time of open reduction in developmental dislocation of the hip in children 12-18 months old. The purpose of this study is to investigate whether concomitant bone surgery is necessary in patients treated with medial open reduction in this age range. Patients that were under 12 months of age at the time of open reduction were compared with patients that were 12-18 months old. Forty-four hips of 30 patients treated with open reduction through Ferguson's medial approach have been included in the study. Mean follow-up was 19.6 years (13-27.5). Age at the time of open reduction was less than 12 months in 21 hips (group A) and 12 months or more in 23 hips (group B). There was no significant difference between two groups concerning avascular necrosis or unsatisfactory radiological outcome (Severin's groups III and IV). A higher rate of secondary bone surgery was necessary in group B than in group A. Although secondary bone surgery is needed at a higher frequency in children 12-18 months old, the radiological outcome is not significantly different for patients younger than 12 months. Therefore, the recommendation of concomitant bone surgery on a routine basis during open reduction in developmental dislocation of the hip in children 12-18 months old is debatable.
SourceAvailable from: Tae-Joon ChoThe Journal of the Korean Orthopaedic Association 01/2009; 44(6). DOI:10.4055/jkoa.2009.44.6.627
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ABSTRACT: The medial open reduction of the developmentally dislocated hip was first described by Ludloff in 1908. It is now typically performed in infants younger than 12 months but has been reported in children up to 24 months of age. The approach most commonly used is between the femoral neurovascular bundle and the pectineus muscle. The advantages to the procedure include the direct approach to all blocks to reduction with minimal blood loss, the ability to perform surgery on bilateral hips during the same operation, and the cosmetic incision. The disadvantages include an increased risk of avascular necrosis, the inability to perform a capsulorrhaphy, and the technical expertise required to successfully navigate the approach. This synopsis reviews the technique for performing a medial open reduction and the recent literature regarding the outcomes.Operative Techniques in Orthopaedics 09/2013; 23(3):109–114. DOI:10.1053/j.oto.2013.07.003
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ABSTRACT: The aim of this study was to compare soft-tissue and bone surgeries in 18-24-month-old patients with developmental dysplasia of the hip (DDH). A total of 77 hips of 53 patients were analyzed. Soft-tissue surgery was performed in 31 hips of 25 patients. In the final examination, 23 hips, excluding hips of eight patients who underwent secondary bone surgery, were evaluated (group I). Bone surgery was performed on 46 hips of 28 patients (group II). In group I, the acetabular index was 41° preoperatively and was 20.4° in the final examinations. In group II, the acetabular index was 42° preoperatively and was 15° in the final examinations. To avoid unnecessary surgeries and complications, soft-tissue surgery should be preferred for DDH in 18-24-month-old patients.Journal of pediatric orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America 07/2013; 22(6). DOI:10.1097/BPB.0b013e328364227e · 0.66 Impact Factor