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Closed reduction of developmental dislocation of the hip in children older than 18 months
P L Schoenecker1, P A Dollard, J J Sheridan
1Shriners Hospital for Crippled Children, St. Louis Unit, St. Louis Children's Hospital, MO 63131-3597, USA.
Insights
Closed reduction is effective for developmental hip dislocation in children over 18 months. Younger age and lower dislocation grade improve success rates for this hip condition.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Background:
- Developmental dislocation of the hip (DDH) is a common pediatric condition.
- Early intervention is crucial for successful treatment outcomes.
- Closed reduction is a primary treatment modality for DDH.
Purpose of the Study:
- To evaluate the long-term success of closed reduction for developmental hip dislocation.
- To identify prognostic indicators for successful closed reduction in DDH patients.
Main Methods:
- Retrospective review of 38 hips in 32 patients aged 18 months or older undergoing closed reduction for DDH.
- Analysis of initial reduction success, casting complications, and long-term outcomes including further surgical interventions.
- Assessment of prognostic factors such as age at reduction and dislocation grade.
Main Results:
- Initial successful closed reduction was achieved in 26 out of 38 hips.
- Three hips required open reduction due to subluxation or dislocation during casting.
- Of the 23 hips with initially successful closed reduction, 11 required no further surgery, while 12 needed osteotomies for remodeling failure. Younger age (<22 months) and lower dislocation grade (I and II) were favorable prognostic indicators.
Conclusions:
- Closed reduction can be a successful treatment for developmental hip dislocation in patients over 18 months.
- Age at reduction and dislocation grade are significant predictors of long-term success.
- While closed reduction offers a viable option, a subset of patients may require subsequent surgical procedures like osteotomies.
Abstract:
Thirty-eight hips in 32 patients > or = 18 months of age had closed reduction attempted for developmental dislocation of the hip. Twenty-six hips in 24 patients had an initially successful closed reduction. During cast treatment three of 26 hips had progressive subluxation or dislocation requiring open reduction with or without concomitant osteotomies. The remaining 23 hips, with an average follow-up of 8 + 8 years, are thought to have had a successful closed reduction. Eleven of those hips have required no further surgical procedures and had an average acetabular index of 18 degrees at last follow-up. Twelve of the 23 hips that had successful closed reduction required a femoral or pelvic osteotomy for failure to remodel. Younger age (< 22 months) at the time of reduction and lower grade (I and II) dislocation were favorable prognostic indicators of the likelihood of successful closed reduction.