A Combined Procedure for High Dislocation in Patients with Developmental Dysplasia of the Hip.

Abstract

A combined procedure including open reduction, femoral shortening osteotomy, and an acetabular procedure is often necessary to obtain a desirable result in children of walking age who have a high-riding hip dislocation. A careful approach to the femoral head and acetabulum is required to avoid injury to nerves, vessels, and cartilage. Make sure to find the true acetabulum and remove all obstacles to femoral head reduction. Check the reducibility of the femoral head in different positions through a full range of hip motion. Expose the proximal part of the femur subperiosteally and make necessary markers for determining the amount of shortening and rotation at the time of osteotomy. Check femoral head reduction stability with the proximal end of the osteotomized femur. Decide the amount of shortening and rotation for the best femoral head reduction. In cases with a dysplastic acetabulum and inadequate femoral head coverage after reduction, perform a Pemberton osteotomy. Apply a hip spica cast, which the patient wears for six weeks; then switch to a hip abduction brace. The patient shown in Figures 26 through 29 and Video 5 was a three-year and six-month-old girl with bilateral developmental dysplasia of the hip that was discovered late (Figs. 26 and 27).IndicationsContraindicationsPitfalls & Challenges.