Congenital dislocation of the hip: a long-term follow-up in Korea

Abstract

The results of fifty-eight congenitally dislocated hips in fifty-four children, who were between two months and eleven years old when treatment was begun, have been reviewed. Thirteen hips were treated by closed reduction, seventeen hips by open reduction, seventeen hips by Salter's innominate osteotomy, five hips by Klisic operation, and six hips by other operations. At an average 5.1 year follow-up (range, three to twelve years), a 91% satisfactory result was obtained when treatment was started under two years of age. With preoperative traction, in the cases when the femoral head was pulled down below to the zero station, the clinical result was satisfactory in 83%. We think that the treatment of congenital dislocation of the hip should be started before two years of age and that the femoral head should be pulled down below to the zero station to prevent avascular necrosis, and to obtain a satisfactory result.

Local mucosal flap for the treatment of gingival defect after gingival fibromatosis excision

“…If conservative treatment fails or the patient presented late, we perform close reduction under anesthesia with or without an adductor tenotomy. This procedure is followed by post reduction immobilization of the affected hip in a spica cast for twelve weeks [1,3,4,6].…”

“…Although largely successful CR may lead to several complications, including AVN of the femoral head and loss of reduction. Even though osteonecrosis is one of the most concerning complications following CR [3,4,[12][13][14], we have not included the evaluation incidence of AVN in this study as this needs prolonged followup. Some authors have suggested 10-12 years of follow-up to ascertain the true incidence of AVN, and others argued that follow-up beyond two years will not identify any additional cases of AVN [4,12,15,16].…”

“…Developmental dysplasia of the hip (DDH) is one of the most common pediatric orthopedic conditions seen in orthopedic clinics [1]. Treatment varies from conservative methods such as Pavlik harness or abduction splints to advanced surgeries with open reduction and acetabular/femoral osteotomies [1][2][3][4]. The treatment aims to achieve a stable, concentric reduction to facilitate normal hip and acetabular growth.…”

“…For those infants who fail initial conservative management or those who present late, treatment often starts with closed reduction (CR) and hip spica. Although this procedure is generally safe and successful, the risk for iatrogenic avascular necrosis (AVN) of the femoral head is a significant concern [4][5][6]. Other problems include redislocation in spica and the need for secondary surgery to address residual acetabular dysplasia [5,6].…”

9- One Stage Combined Surgical Treatment for Developmental Dislocation of the Hip in Older Children Including Femoral Shortening

“…Whereas others performed open reduction and Salter innominate osteotomy in the same age group without femoral shortening 6,[17][18][19] . Avascular necrosis (AVN) is a serious complication in the treatment of DDH 3,10,20,21 .…”