Neglected, developmental hip dislocation treated with external iliofemoral distraction, open reduction, and pelvic osteotomy

Abstract

Between 1995 and 2003, we operated upon 18 children with 20 hips involved, aged 5-11 years (average: 7.5 years) suffering from an inveterate high developmental dislocation of the hip joint. An average follow-up period of our middle-term study was 51 months (range: 34-96 months). A two-staged management was applied. First, femoral head was lowered back to the level of acetabulum with an external fixator or a distractor device. The second stage involved open reduction combined with pelvic osteotomy and, in four cases with femoral derotation osteotomy. We noted two cases of avascular necrosis. Equal limb length was achieved in 15 cases. There were two cases of 0.5-cm length discrepancy, two cases of 1-cm length inequalities, and one case of 5-cm limb shortening. We endorse this method in neglected cases of previously untreated unilateral high developmental hip dislocations in children aged 8-10 years. It results in a usable hip joint without the need of femoral shaft shortening and facilitates future joint replacement.

Predictors of femoral shortening for pediatric developmental hip dysplasia surgery: an observational study in 435 patients

“…In the past, femoral shortening was considered only for patients who did not respond to prolonged preoperative traction [ 6 ]. An alternative to skeletal traction is an external distractor, which Wojciechowski et al used to lower the femoral head before open reduction and acetabuloplasty [ 7 ]. This method, however, entails two-stage surgery and carries the additional risk of pin site infection.…”

Neglected Dislocation in Adults: A New Therapeutic Strategy for an Uncommon Condition

“…However, extending its use to pediatric patients is not suggested. The efficacy rates are below 50%, and its benefits do not exceed the complications, including long hospital stays, difficult postoperative care, and complex joint repositioning due to pelvic instability [6,10].…”

“…Our method of choice, arthrodiastasis, has been used since 1979 to perform joint distraction by external fixation with monolateral or Ilizarov-type devices to treat multiple conditions, including femoral neck fractures, osteoarthritis, sequelae of Perthes disease, epiphysiolysis, or chondrolysis [6,8,[24][25][26][27].…”

“…Using fixators for distraction reduces patient traction discomfort, allows early hip mobility, and facilitates subsequent care, in addition to providing positive effects on bone regeneration and chondroprotection both on the femoral head and acetabulum and increasing the blood supply to adjacent tissues. Moreover, it can ease the challenge faced by the patient's caretaker in providing assistance, which can be rather difficult in cases like the one presented here [6,25,26].…”

“…Due to the low frequency of cases in clinical practice, there is no consensus on the therapeutic approach to neglected dislocations in adults, as the literature only reports isolated cases. Their management is based on that of traumatic, congenital or pediatric hip dislocations, which have been more commonly reported and extensively described [2,[5][6][7].…”