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Management of DDH in children between age of (1-2.5) years old by open reduction & derotation osteotomy without pelvic osteotomy

Authors: Raed Abbas Saadoon --- Mohammed Jafer Jawad
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2016 Volume: 15 Issue: 2 Pages: 1-8
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background; Developmental dysplasia of the hip (DDH) means femoral head subluxation or dislocation and/or acetabular dysplasia. Management of neglected (DDH) in children after the walking age is challenging to the orthopedic surgeons. It is usually surgically demanding procedures at this age group. There will be always children who reach walking age with DDH, either secondary to failed treatment or delayed diagnosis. Aims: To evaluate the results of open reduction & derotation osteotomy in treatment of DDH in children without pelvic osteotomy. Methods: At the Orthopedic Department in AL-Yarmook hospital from the period of December 2010 to November 2015. Twenty-three patients (3 patients had bilateral DDH) [26 hip joints] with DDH, the age of patients at time of the operation ranged from (12-30) months, treatment done in two stages open reduction (1st stage) and derotation osteotomy of femur (2nd stage), except Five cases, we did open reduction, shortening & derotation osteotomy in one session because of difficulty in reduction. Final functional & clinical evaluation of patients were done according to a combination of modified MacKay criteria and modified Harris hip score. Radiological evaluation at the end of follow-up was done according to the modified Severin radiographic criteria. Results: - The overall final clinical results were excellent in 8 hips (30.8%), good in 16 hips (61.6%), fair in one hip (3.8%) and poor in one (3.8%), satisfactory (excellent and good) in 24hips (92.3%) and unsatisfactory (fair and poor) in 2 hips (7.7%).The radiological end result was Class I (excellent) in 15 hipss (57.7%), Class II (good) in 10 (38.5%), Class III (fair) in one (3.8%). The results were satisfactory in 25 (96%) hips and unsatisfactory in one (4%) hip. Conclusion: We concluded that operative treatment of neglected DDH ( after the age of walking ) is a surgically demanding procedure but when it performed properly by an open reduction & derotation osteotomy with spending good time for cleaning of acetabulum & excise part of capsule with secure capsulorraphy without need for pelvic osteotomy for those children below age of 2.5 years old.

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