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

INTRODUCTION

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.

STEP 1 SURGICAL APPROACH: A careful approach to the femoral head and acetabulum is required to avoid injury to nerves, vessels, and cartilage.

STEP 2 EXPLORE THE HIP JOINT: Make sure to find the true acetabulum and remove all obstacles to femoral head reduction.

STEP 3 FEMORAL HEAD REDUCIBILITY: Check the reducibility of the femoral head in different positions through a full range of hip motion.

STEP 4 FIRST FEMORAL OSTEOTOMY: 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.

STEP 5 HIP JOINT STABILITY: Check femoral head reduction stability with the proximal end of the osteotomized femur.

STEP 6 FEMORAL SHORTENING: Decide the amount of shortening and rotation for the best femoral head reduction.

STEP 7 PEMBERTON ACETABULOPLASTY: In cases with a dysplastic acetabulum and inadequate femoral head coverage after reduction, perform a Pemberton osteotomy.

STEP 8 POSTOPERATIVE MANAGEMENT: Apply a hip spica cast, which the patient wears for six weeks; then switch to a hip abduction brace.

RESULTS

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.