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Risk factors for failed closed reduction in dislocated developmental dysplastic hips.

Sebastian Gottfried Walter1,2, Christoph Hans-Jürgen Endler3, Anna Christina Remig3

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Enlarged femoral head volume and its ratio to acetabular opening predict unsuccessful closed reduction (CR) in developmental dysplasia of the hip (DDH). This finding aids in identifying hips at risk for CR failure.

Keywords:
AcetabulumClosed reductionCongenitalDDHFemoral headHip dislocation

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Area of Science:

  • Orthopedic surgery
  • Pediatric orthopedics
  • Radiology

Background:

  • Developmental dysplasia of the hip (DDH) is a common condition requiring treatment.
  • Closed reduction (CR) is the standard treatment for DDH, but success rates are not 100%.
  • Identifying factors predicting CR failure is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To identify risk factors associated with unsuccessful closed reduction (CR) in developmental dysplasia of the hip (DDH).
  • To evaluate the predictive value of femoral head volume and its relationship with acetabular dimensions for CR success.

Main Methods:

  • Seventy-three dysplastic hips underwent closed reduction followed by pelvic MRI.
  • MRI assessed hip reduction, femoral head volumes, and acetabular diameter.
  • Correlation of initial treatment results with acetabular-cervical (AC) angles at 2-year follow-up.

Main Results:

  • Nine out of 73 hips showed CR failure.
  • CR failure cases had significantly increased femoral head volumes (p=0.002).
  • A larger ratio of femoral head volume to acetabular opening area was significantly associated with CR failure (p=0.02).
  • Pathologic AC angles at 2-year follow-up were observed in CR failure cases (p=0.003).

Conclusions:

  • Exclusive femoral head enlargement is a risk factor for unsuccessful CR in DDH.
  • The ratio of femoral head volume to acetabular opening area predicts CR success in DDH.
  • These findings can help clinicians anticipate and manage cases of CR failure.