Closed reduction with or without adductor tenotomy for developmental dysplasia of the hip presenting at walking age
Ahmed Samir Barakat1, Abou Bakr Zein1, Amr Said Arafa1
1Orthopedics and Traumatology Department, Cairo University, Egypt.
Insights
Closed reduction is an effective treatment for developmental dislocation of the hip in older children, even in resource-limited settings. Prompt management and surgical expertise are key to successful outcomes.
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip (DDH)
Background:
- Developmental dislocation of the hip (DDH) often goes undiagnosed in children reaching walking age, particularly in underdeveloped countries.
- Delayed diagnosis can negatively impact a child's growth and development.
- There is a need for affordable and effective treatments in regions with limited medical services.
Purpose of the Study:
- To evaluate the outcomes of treating children with developmental dislocation of the hip using closed reduction.
- To assess the efficacy of closed reduction with or without adductor tenotomy in older children.
- To determine the feasibility of this treatment in resource-limited settings.
Main Methods:
- A prospective study involving 20 patients with 29 affected hips (ages 9-36 months).
- Patients were divided into two age groups: 9-18 months and 19-36 months.
- Treatment involved closed reduction, with or without adductor tenotomy, followed by a mean 21-month follow-up.
Main Results:
- Closed reduction failure rates were 14.3% in the younger group and 13.3% in the older group, necessitating open reduction in these cases.
- Four hips developed avascular necrosis; three required no further intervention, and one underwent open reduction.
- The overall success rate indicates the viability of closed reduction as a primary treatment.
Conclusions:
- Closed reduction is a valid and reproducible treatment for developmental dislocation of the hip in older children when performed by experienced surgeons.
- Close follow-up and prompt management of complications, including timely conversion to open reduction, are crucial.
- This approach offers a cost-effective solution for DDH in underserved populations.
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.
