Treatment of congenital dislocation of the hip in older children

The aims of treatment of a child with congenital dislocation of the hip (CDH) untreated until walking age should be to reestablish the mechanics of the hip joint and avoid complications, especially avascular necrosis, thus delaying the development of osteoarthritis. The pathology in the older child shows that both soft tissues and bony parts are distorted to some degree. The acetabular index and center-edge (CE) angle evaluations are helpful in the initial evaluation and in the follow-up examinations. A computed tomography (CT) scan may be helpful in determining a reduction and distinguishing between dysplasia and subluxation. A controversy still exists as to the relative value of closed and open reduction in the treatment of a child who has reached walking age. For most surgeons, in a child up to three years of age, a careful closed reduction following a period of traction is the most useful form of treatment. The home traction program has been successful in this age group. For gentle closed reduction all maneuvers must be done as gently as possible and carried out as "positioning" the leg rather than forcing a reduction. The indications for open reduction are (1) if the femoral head persistently lies above the triradiate cartilage on roentgenographic examination, (2) if the arc of reduction and redislocation is less than 25 degrees after an adductor tenotomy, (3) if the femoral head will not enter the acetabulum, (4) if the femoral head is still laterally placed in the acetabulum after four weeks of partial reduction, and (5) if a previous reduction has failed.(ABSTRACT TRUNCATED AT 250 WORDS)