Modified Capsulorrhaphy Technique in Open Reduction of Developmental Dysplasia of the Hip.

BACKGROUND: Neglected patients with developmental dysplasia of the hip (DDH) are not uncommon. Various treatment modalities have been used. Capsulorrhaphy is one of the most critical steps during the process of open reduction of DDH. Inadequate capsulorrhaphy technique can increase the failure rate of open reduction procedures. This study presented the clinical and radiographic results of using a new capsulorrhaphy technique. METHODS: Between November 2005 and March 2018, 540 DDH in 462 patients were retrospectively reviewed. The mean age at surgery was 31 months. All patients underwent a modified capsulorrhaphy technique developed by the main author (with or without additional pelvic or femoral procedures). Postoperative patient assessment during the follow-up period was performed both clinically and radiologically. RESULTS: Follow-up period ranged between 36 months and 12 years. Based on the modified McKay score, good and excellent outcomes were obtained in 90.3%. Functional results were better in younger age (less than 39 mo). Both acetabular index and lateral center edge angle showed significant improvement at 3 years follow-ups. Proximal femoral growth disturbance (PFGD) was encountered in 92 hips. Classes 2 and 3 did not affect the functional results, whereas patients with PFGD classes 4 and 5 had fair to poor functional outcomes. There were 12 hips with redislocation. Revision was done using the same capsulorrhaphy technique. CONCLUSION: Using the index technique of capsulorrhaphy in DDH surgery is safe, reliable, and yields good functional and radiologic outcomes with a relatively low complication rate. LEVEL OF EVIDENCE: Level IV-therapeutic retrospective case series.

Dega osteotomy for the management of developmental dysplasia of the hip in children aged 2-8 years: results of 58 consecutive osteotomies after 13-25 years of follow-up.

PURPOSE: Developmental dysplasia of the hip (DDH) is a term used to cover a broad spectrum of anomalies ranging from mild dysplasia to high-riding dislocations. We report the management of DDH in children using the Dega osteotomy and their long-term follow-up. METHODS: Fifty-eight hips from 48 children younger than 8 years treated using the Dega osteotomy between January 1988 and October 2000 were included in this multcenter study. Both prospective (41 hips) and retrospective (17 hips) cases were included, and follow-up was for a minimum of 13 years. Radiographs were made preoperatively, immediately postoperatively, after 6 weeks or at removal of the spica cast if any, at 6-month intervals and/or as indicated for 3 years postoperatively and then on annual basis until the last follow-up. A single-cut computed tomographic scan was performed for all prospective patients. Special attention was paid to the predictive measures of hip arthrosis and the survival of the hip after Dega osteotomy. RESULTS: The final clinical outcome was favorable in 44 hips (75.9 %). Eleven hips needed a second surgery (acetabuloplasty and/or arthroplasty) during the follow-up period. CONCLUSIONS: In our pediatric patient population the Dega osteotomy proved to be an adequate measure for the management of this complex condition. The worst complication was avascular necrosis, and all of the affected hips ended with failure (pain, another surgery, or both).

Surgical management of complex humerus head fractures.

The locked plate systems provided adequate fixation of osteoporotic fractures of the proximal humerus in the elderly. But is the PHILOS plate adequate for stabilization of high-energy fractures, and fracture-dislocations of the proximal humerus in relatively younger age populations? In this retrospective study, performed at a referral, academic supervised, level III-trauma center, all high-energy trauma patients under the age of 55 years, with closed, 3 part, 4 part fractures, and/or fracture dislocations, were included in this study. Patients with open fractures, osteoporotic low-energy fractures, as well as patients older than 55 years were excluded. Fifty-nine patients entered and completed the study. They were all managed by open reduction and internal fixation using the PHILOS plate system. Patients' age ranged between 31-52 years, with a mean of 42 years. A minimal follow-up period of two years was a mandatory inclusion criterion in this study. All the patients who did not complete the follow-up period were excluded from the study. The results were evaluated using the Constant, Neer and DASH scoring systems, which revealed favorable results in 41 patients (69.5%). The results were comparable to the recent articles published in the literature in relatively older age groups. It was concluded that, despite the relatively high rate of complications encountered in the management of these complicated high-energy fractures, the PHILOS plating system could be considered an adequate management of polytrauma patients.

Single-stage open reduction, Salter innominate osteotomy, and proximal femoral osteotomy for the management of developmental dysplasia of the hip in children between the ages of 2 and 4 years.

The management of neglected developmental dysplasia of the hip in walking children has always been a challenge to orthopedic surgeons. The aim of this study was to access the early clinical and radiographic results of surgical treatment of such cases using one-stage open reduction, Salter innominate osteotomy, and proximal femoral osteotomy. Seventy-one surgeries were performed in 55 patients. Favorable clinical and radiographic outcomes were comparable to other studies. We concluded that this single-stage surgery is a technically demanding, but satisfactory procedure in the management of neglected developmental dysplasia of the hip patients, and when performed adequately in indicated patients in specialized centers, it is expected to give good short-term results.