The Success of Closed Reduction in the Treatment of Complex Developmental Dislocation of the Hip

Fleissner, Paul R.; Ciccarelli, Carmine J.; Eilert, Robert E.; Chang, Frank M.; Glancy, Gerard L.

doi:10.1097/01241398-199409000-00016

Cited by 25 publications

(15 citation statements)

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“…Closed reduction was considered to have been achieved if the reduction was concentric and stable with a satisfactory safety zone (the arc between the angle of maximal achievable abduction [80°–90°] that can be attained comfortably and the angle that allows redislocation with the hip 90°–100° flexion: >30°). [34,35] When closed reduction failed or the hip was unstable, open reduction was performed. Open surgery included routine excision of the ligamentum teres, division of the inferior transverse ligament, and eversion of the limbus where necessary.…”

Section: Methodsmentioning

confidence: 99%

Association between open or closed reduction and avascular necrosis in developmental dysplasia of the hip

Wang¹,

Yang²,

Wu³

et al. 2016

Medicine

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Section: Methodsmentioning

confidence: 99%

Association between open or closed reduction and avascular necrosis in developmental dysplasia of the hip

Wang¹,

Yang²,

Wu³

et al. 2016

Medicine

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“…All infants were examined while under general anesthesia. An attempt was made to perform a closed reduction [5] after performing a percutaneous tenotomy of the adductor longus in infants younger than 15 months. As per individual preference, two surgeons routinely used arthrography to determine the position of the hip before reduction, whereas one surgeon used intraoperative ultrasound or image intensification for this purpose.…”

Section: Methodsmentioning

confidence: 99%

The Presence of an Ossific Nucleus Does Not Protect Against Osteonecrosis After Treatment of Developmental Dysplasia of the Hip

Roposch

Odeh

Doria

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Osteonecrosis (ON) is a major complication after treatment of developmental dysplasia of the hip (DDH). Several studies have explored the absence of the femoral head ossific nucleus at the time of hip reduction as a risk factor for the development of ON, but findings have been inconsistent. Questions/purposes We therefore determined the incidence of ON in children who underwent reduction of a dislocated hip in the presence or absence of the ossific nucleus. Patients and MethodsWe retrospectively reviewed the radiographs of 105 hips in 89 patients treated for DDH at the age of 18 months or younger. Radiographs were graded for the presence of the ossific nucleus at the time of hip reduction and for the presence of ON, as graded by the Bucholz and Ogden classification, for patients at a mean age of 10 years. We used log-binomial regression to estimate if the presence of the ossific nucleus was associated with a lower incidence of ON. Results We identified ON in 37 of the 105 hips (35%). The incidence of ON at 10 years was 40% in the absence of the ossific nucleus and 32% in the presence of the ossific nucleus (adjusted relative risk, 0.86; 95% confidence interval, 0.36-1.81). When only radiographic changes of Grade II and greater were considered ON, the risk was still not increased (relative risk, 1.26; 95% confidence interval, 0.62-2.56). Conclusion Patients with an ossific nucleus at the time of hip reduction showed a slight tendency toward better outcomes. The ossific nucleus did not protect for ON. Level of Evidence Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…Another important factor in assessing the quality of reduction is how much stable is the reduction which can be assessed manually by determining the safe zone of Ramsay as wide, moderate or narrow safe zone. 2,6,9 Difficulties and Complications A few restrains were encountered during the procedure. If the stilette was left in while introducing, the needle did not choke and when entered into the joint, it may lodge into soft tissues either placed normally or abnormally.…”

Section: Discussionmentioning

confidence: 99%

“…Under fluoroscopic guide a 10-cm long 22G lumber puncture needle 7 inserted into the hip joint through anterior approach. 7 Saline was pushed in to confirm the position of the needle and then the diluted radio-opaque dye (3cc) 2 was injected into the hip joint and images taken in extension,90degree flexion 45-degree abduction with external rotation and adduction with internal rotation 3,5,7 and variables like shape of head of femur, shape of acetabulum, labrum, ligamentum teres, containment of the hip, coverage of head and external obstacles to reduction 2,5,6,7,8,9 were noted. If hip was concentrically reduced hip spica cast in human position was applied.…”

Section: Methodsmentioning

confidence: 99%

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Role of arthrography in assessing the closed reduction in treatment of DDH.

Shahzad

Khan

Iqbal

et al. 2019

TPMJ

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Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal problems in newborns. It occurs in 1in 1000 live births affecting girls more than boys and more associated with breech presentation and positive family history. Objectives: To evaluate the effectiveness of arthrography in assessing the closed reduction of DDH. Study Design: Observational. Setting: This study was conducted at Allied Hospital, Faisalabad, Pakistan, Period: From December 2013 to January 2016 and comprised patients of either gender. Material & Methods: DDH was diagnosed with help of clinical examination and radiological investigations. Arthrography was performed and images were taken in different positions of the hip which were evaluated and findings noted. Results: Out of 50 hips, 34 had normal looking head of femur while 16 patients had head of femur which was either smaller than normal or of abnormal shape. Shape of acetabulum was found normal in 41 hips. Normal labrum was present in 44, inverted in 4 and everted in 2 patients. Ligamentum teres was found hypertrophic in 6 patients. Normal head coverage was present in 40 while in 10 hips head of femur was lateralized ≥ 4 mm. No external obstruction to reduction was encountered. In 44 cases reduction was concentric and eccentric reduction was noted in 6 patients. Conclusion: Arthrography is of special help in assessing the reduction of hip in DDH as it provides information about shape of head of femur, shape of acetabulum, labrum, ligamentum teres, containment of the hip, coverage of head and external obstacles to reduction.

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The Success of Closed Reduction in the Treatment of Complex Developmental Dislocation of the Hip

Cited by 25 publications

References 0 publications

Association between open or closed reduction and avascular necrosis in developmental dysplasia of the hip

Association between open or closed reduction and avascular necrosis in developmental dysplasia of the hip

The Presence of an Ossific Nucleus Does Not Protect Against Osteonecrosis After Treatment of Developmental Dysplasia of the Hip

Role of arthrography in assessing the closed reduction in treatment of DDH.

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