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9- ONE STAGE COMBINED SURGICAL TREATMENT FOR DEVELOPMENTAL DISLOCATION OF THE HIP IN OLDER CHILDREN INCLUDING FEMORAL SHORTENING

Ali A Al-Iedan

Basrah Journal of Surgery مجلة البصرة الجراحية
ISSN: 16833589 Year: 2011 Volume: 17 Issue: 1 Pages: 58
Publisher: Basrah University جامعة البصرة

Abstract

Ali A Al-IedanMBChB, CABS, Lecturer in Orthopaedics, Department of Surgery, College of Medicine, University ofBasrah, Basrah – Iraq.AbstractThe treatment of developmental dislocation of the hip (DDH) in older children is a challengebecause they have high displacement of the hip, contracted soft tissues, insufficiency of theacetabulum and increased anteversion of the femoral head. In such patients it is difficult toreduce the femoral head into the acetabulum, maintain the concentric reduction and obtain asatisfactory functional hip joint. The aim of this study is to assess the advantage anddisadvantage of one stage combined surgery with femoral shortening in treatment of DDH inchildren above 2 years old.This is a prospective study done in Al-Basrah General Hospital between (June 2008-June2010), thirty patients were treated (35 hips), 28 females and 2 males. Five hips were right hipdislocation, 20 hips were left and 5 patients were bilateral. Femoral shortening done for all thehips and, in 28 hips pelvic osteotomy were performed at the time of open reduction. At the mostrecent follow-up (4 months-2 years) According to the radiographic criteria of Severin, 5 hipswere excellent, 15 hips good and 10 hips have fair results, 5 end up hips had poor outcome.Avascular necrosis developed in 5 of the 35 hips. All patients were followed with respect torange of motion and recovery from limb-length discrepancy. Different complications wererecorded per or postoperatively. Some complications like pelvic fracture (1 hip), subluxation andinstability (3 hips), dislocation (2 hips) and stiffness (7 hips).According to the rating system of Mckay's clinical criteria, there were 7 hips excellent, 11 hipsgood, 12 hips fair results and 5 hips had a poor result.It is concluded that children who are two years or older and have DDH, can safely be treatedwith an extensive one-stage operation consisting of open reduction combined with femoralshortening and pelvic osteotomy, without increasing the risk of avascular necrosis. The limblength discrepancy that is produced by the shortening does not appear to cause a clinicalproblem.

Keywords

DISLOCATION OF THE HIP --- OLDER CHILDREN --- FEMORAL SHORTENING