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Management of developmental dysplasia of the hip in less than 24 months old children

BACKGROUND: There is no consensus on the treatment of developmental dysplasia of the hip in children less than 24 months of age. The aim of this study was to present the results of open reduction and concomitant primary soft-tissue intervention in patients with developmental dysplasia of the hip in...

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Autores principales: Bulut, Mehmet, Gürger, Murat, Belhan, Oktay, Batur, Omer Cihan, Celik, Suat, Karakurt, Lokman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868139/
https://www.ncbi.nlm.nih.gov/pubmed/24379463
http://dx.doi.org/10.4103/0019-5413.121584
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author Bulut, Mehmet
Gürger, Murat
Belhan, Oktay
Batur, Omer Cihan
Celik, Suat
Karakurt, Lokman
author_facet Bulut, Mehmet
Gürger, Murat
Belhan, Oktay
Batur, Omer Cihan
Celik, Suat
Karakurt, Lokman
author_sort Bulut, Mehmet
collection PubMed
description BACKGROUND: There is no consensus on the treatment of developmental dysplasia of the hip in children less than 24 months of age. The aim of this study was to present the results of open reduction and concomitant primary soft-tissue intervention in patients with developmental dysplasia of the hip in children less than 24 months of age. MATERIALS AND METHODS: Sixty hips of 50 patients (4 male, 46 female) with mean age of 14.62 ± 5.88 (range 5-24 months) months with a mean followup of 40.00 ± 6.22 (range 24-58 months) months were included. Twenty five right and 35 left hips (10 bilaterally involved) were operated. Open reduction was performed using the medial approach in patients aged < 20 months (with Tönnis type II-III and IV hip dysplasias) and for those aged 20-24 months with Tönnis type II and III hip dysplasias (n = 47). However for 13 patients aged 20-24 months with Tönnis type IV hip dysplasias, anterior bikini incision was used. RESULTS: Mean acetabular index was 41.03 ± 3.78° (range 34°-50°) in the preoperative period and 22.98 ± 3.01° (range 15°-32°) at the final visits. Mean center-edge angle at the final visits was 22.85 ± 3.35° (18°-32°). Based on Severin radiological classification, 29 (48.3%) were type I (very good), 25 (41.7%) were type II (good) and 6 (10%) were type III (fair) hips. According to the McKay clinical classification, postoperatively the hips were evaluated as excellent (n = 42; 70%), good (n = 14; 23.3%) and fair (n = 4; 6.7%). Reduction of all hip dislocations was achieved. Additional pelvic osteotomies were performed in 14 (23.3%) hips for continued acetabular dysplasia and recurrent subluxation. (Salter [n = 12]/Pemberton [n = 2] osteotomy was performed). Avascular necrosis (AVN) developed in 7 (11.7%) hips CONCLUSION: In DDH only soft-tissue procedures are not enough, because of the high rate of the secondary surgery and AVN for all cases aged less than 24 months. Bone procedures may be necessary in the walking age group with high acetabular index.
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spelling pubmed-38681392013-12-30 Management of developmental dysplasia of the hip in less than 24 months old children Bulut, Mehmet Gürger, Murat Belhan, Oktay Batur, Omer Cihan Celik, Suat Karakurt, Lokman Indian J Orthop Original Article BACKGROUND: There is no consensus on the treatment of developmental dysplasia of the hip in children less than 24 months of age. The aim of this study was to present the results of open reduction and concomitant primary soft-tissue intervention in patients with developmental dysplasia of the hip in children less than 24 months of age. MATERIALS AND METHODS: Sixty hips of 50 patients (4 male, 46 female) with mean age of 14.62 ± 5.88 (range 5-24 months) months with a mean followup of 40.00 ± 6.22 (range 24-58 months) months were included. Twenty five right and 35 left hips (10 bilaterally involved) were operated. Open reduction was performed using the medial approach in patients aged < 20 months (with Tönnis type II-III and IV hip dysplasias) and for those aged 20-24 months with Tönnis type II and III hip dysplasias (n = 47). However for 13 patients aged 20-24 months with Tönnis type IV hip dysplasias, anterior bikini incision was used. RESULTS: Mean acetabular index was 41.03 ± 3.78° (range 34°-50°) in the preoperative period and 22.98 ± 3.01° (range 15°-32°) at the final visits. Mean center-edge angle at the final visits was 22.85 ± 3.35° (18°-32°). Based on Severin radiological classification, 29 (48.3%) were type I (very good), 25 (41.7%) were type II (good) and 6 (10%) were type III (fair) hips. According to the McKay clinical classification, postoperatively the hips were evaluated as excellent (n = 42; 70%), good (n = 14; 23.3%) and fair (n = 4; 6.7%). Reduction of all hip dislocations was achieved. Additional pelvic osteotomies were performed in 14 (23.3%) hips for continued acetabular dysplasia and recurrent subluxation. (Salter [n = 12]/Pemberton [n = 2] osteotomy was performed). Avascular necrosis (AVN) developed in 7 (11.7%) hips CONCLUSION: In DDH only soft-tissue procedures are not enough, because of the high rate of the secondary surgery and AVN for all cases aged less than 24 months. Bone procedures may be necessary in the walking age group with high acetabular index. Medknow Publications & Media Pvt Ltd 2013 /pmc/articles/PMC3868139/ /pubmed/24379463 http://dx.doi.org/10.4103/0019-5413.121584 Text en Copyright: © Indian Journal of Orthopaedics http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Bulut, Mehmet
Gürger, Murat
Belhan, Oktay
Batur, Omer Cihan
Celik, Suat
Karakurt, Lokman
Management of developmental dysplasia of the hip in less than 24 months old children
title Management of developmental dysplasia of the hip in less than 24 months old children
title_full Management of developmental dysplasia of the hip in less than 24 months old children
title_fullStr Management of developmental dysplasia of the hip in less than 24 months old children
title_full_unstemmed Management of developmental dysplasia of the hip in less than 24 months old children
title_short Management of developmental dysplasia of the hip in less than 24 months old children
title_sort management of developmental dysplasia of the hip in less than 24 months old children
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3868139/
https://www.ncbi.nlm.nih.gov/pubmed/24379463
http://dx.doi.org/10.4103/0019-5413.121584
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