Early Surgery for DDH - Simon Coleridge 31/10/2000
1. Early operative management is required after failure of the Pavlik Harness, or late diagnosis.
2. Options are closed reduction under GA in those of 6 -12 months plus hip spica or for those from 1 - 3yrs who have been walking this will require open reduction and adductor tenotomy plus hip spica.
3. Reduction closed or open is usually accompanied by an arthrogram, which is only of use when the ossific nucleus has formed at 3 - 4 months. U/S should be used until this time.
4. Late diagnosis may require 1 week of traction pre-op.
5. The hip should be held at 100 ° of flexion and 60 ° of abduction to avoid AVN.
6. Treatment in spica is determined by the response of the hip. (18 weeks with change to broomsticks at 12)
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Brief
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GABUZA JBJS (A) 1992
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Author
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Gabuzda GM and Renshaw TS. (Newington, Connecticut.)
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Title
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Reduction of Congenital Dislocation of the Hip. Current Concepts Review.
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Reference
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JBJS 1992; 74-A:624-630
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Summary
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Discusses the uses of closed and/or open reduction following either failure of the Pavlik Harness or late diagnosis. Also raises the complication of AVN either with or without intervention. Plus the most popular methods of open reduction.
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Critique
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Good review article of management of infants with DDH who have not responded to conservative management who are under 2 yrs when diagnosed.
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Brief
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MORCUENDE JBJS (A) 1997
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Author
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Morcuende JA and Weinstein SL et al. (Iowa.)
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Title
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Long-term Outcome after open reduction through an Anteromedial Approach for CDH.
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Reference
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JBJS 1997; 79-A:810-817
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Summary
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Under 2 years of age the anteromedial approach was proven to be useful operation for open reduction. Allowing good access to the obstacles to reduction. A high hip dislocation after 24 months and an association with increased femoral head growth disturbance. 53% did not have AVN.
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