Closed reduction with or without adductor tenotomy for developmental dysplasia of the hip presenting at walking age

Abstract

Background:Many children with developmental dislocation of the hip especially in underdeveloped countries reach walking age and still remain undiagnosed, which can be detrimental to their growth and development. Because of the lack medical services often encountered in these regions, it would be attractive to find a cheap and effective treatment. Our work evaluated the results of treatment of these children by closed reduction with or without adductor tenotomy in a prospective study.Methods:We included 20 patients in this study with 29 affected hips (15 right and 14 left). Nine patients (45%) had bilateral DDH and 11 (55%) had unilateral DDH. There were 18 girls (90%) and two boys (10%) who were followed up for a mean of 21 mo (18-24 mo). Ages ranged from 9 to 36 mo (mean age 18.3 mo). Patients were divided according to age into two groups: between 9-18 mo and from 19-36 mo. The first group included nine patients (14 hips) while the second had 11 patients (15 hips).Results:In the first group, closed reduction failed in two patients (two hips) during the follow-up period (14.3%) and this necessitated shift to open reduction, while in the second group only one patient (bilateral DDH) had a similar failure (13.3%). We identified four hips with avascular necrosis. Three of them required no further treatment, the remaining hip was openly reduced.Conclusions:Closed reduction in older children offers a valid and reproducible treatment modality in the hands of an experienced pediatric orthopaedic surgeon as long as there is close follow-up and thorough knowledge of possible complications and their management including the ability to shift timely to open reduction.

Efficacy of closed reduction for developmental dysplasia of the hip: midterm outcomes and risk factors associated with treatment failure and avascular necrosis

“…Terjesen et al [24] reported that the most important independent risk factors for a poor long-term outcome was an age of eighteen months or older at the time of reduction. On the contrary, Barakat et al [25] concluded that CR in children between 19 procedures [26] . Herein, we observed the similar outcomes that patients older than 18.35 months at the age of CR may have poor outcomes when compared with younger patients.…”

Acetabular Dysplasia: a Modern View of the Problem (Literature Review)

“…Наступним методом лікування є застосування іммобілізації кульшових суглобів у фізіологічно-вигідному положенні у гіпсовій пов'язці [1,4]. Інколи закрите вправлення комбінують із застосуванням артрографії та/або міотомії аддукторів [20]. Успіх закритого вправлення залежить від віку (чим старша дитина, тим більші зміни виникають у кульшовому суглобі та тканинах навколо суглоба) [16].…”

Degenerative hip disorders in children

“…до 2 лет, однако при наличии тяжелой степени болезни (выраженное недоразвитие вертлужной впадины, высокий вывих) допускается хирургическое лечение с 6 мес. [15,16]. Типичным же считается применение хирургического метода у детей от двух лет и старше [15,16].…”

“…[15,16]. Типичным же считается применение хирургического метода у детей от двух лет и старше [15,16].…”

“…К консервативным вариантам лечения относится функциональный метод с использованием стремян Павлика и отводящих шин различных модификаций, которые позволяют добиться хороших результатов при нестабильных формах ДТС [16,17]. Функциональные приспособления создают оптимальные условия для вправления головки путем постепенной коррекции, этому также способствует и хорошая растяжимость капсульносвязочного аппарата детей до года.…”