Ting-Ming Wang1, Kuan-Wen Wu1, Shier-Chieg Huang1, Wei-Cheng Huang1, Ken N Kuo2. 1. Department of Orthopaedic Surgery, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan. 2. School of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan. E-mail address: kennank@aol.com.
Abstract
INTRODUCTION: A combined procedure including open reduction, femoral shortening osteotomy, and an acetabular procedure is often necessary to obtain a desirable result in children of walking age who have a high-riding hip dislocation. STEP 1 SURGICAL APPROACH: A careful approach to the femoral head and acetabulum is required to avoid injury to nerves, vessels, and cartilage. STEP 2 EXPLORE THE HIP JOINT: Make sure to find the true acetabulum and remove all obstacles to femoral head reduction. STEP 3 FEMORAL HEAD REDUCIBILITY: Check the reducibility of the femoral head in different positions through a full range of hip motion. STEP 4 FIRST FEMORAL OSTEOTOMY: Expose the proximal part of the femur subperiosteally and make necessary markers for determining the amount of shortening and rotation at the time of osteotomy. STEP 5 HIP JOINT STABILITY: Check femoral head reduction stability with the proximal end of the osteotomized femur. STEP 6 FEMORAL SHORTENING: Decide the amount of shortening and rotation for the best femoral head reduction. STEP 7 PEMBERTON ACETABULOPLASTY: In cases with a dysplastic acetabulum and inadequate femoral head coverage after reduction, perform a Pemberton osteotomy. STEP 8 POSTOPERATIVE MANAGEMENT: Apply a hip spica cast, which the patient wears for six weeks; then switch to a hip abduction brace. RESULTS: The patient shown in Figures 26 through 29 and Video 5 was a three-year and six-month-old girl with bilateral developmental dysplasia of the hip that was discovered late (Figs. 26 and 27).IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: A combined procedure including open reduction, femoral shortening osteotomy, and an acetabular procedure is often necessary to obtain a desirable result in children of walking age who have a high-riding hip dislocation. STEP 1 SURGICAL APPROACH: A careful approach to the femoral head and acetabulum is required to avoid injury to nerves, vessels, and cartilage. STEP 2 EXPLORE THE HIP JOINT: Make sure to find the true acetabulum and remove all obstacles to femoral head reduction. STEP 3 FEMORAL HEAD REDUCIBILITY: Check the reducibility of the femoral head in different positions through a full range of hip motion. STEP 4 FIRST FEMORAL OSTEOTOMY: Expose the proximal part of the femur subperiosteally and make necessary markers for determining the amount of shortening and rotation at the time of osteotomy. STEP 5 HIP JOINT STABILITY: Check femoral head reduction stability with the proximal end of the osteotomized femur. STEP 6 FEMORAL SHORTENING: Decide the amount of shortening and rotation for the best femoral head reduction. STEP 7 PEMBERTON ACETABULOPLASTY: In cases with a dysplastic acetabulum and inadequate femoral head coverage after reduction, perform a Pemberton osteotomy. STEP 8 POSTOPERATIVE MANAGEMENT: Apply a hip spica cast, which the patient wears for six weeks; then switch to a hip abduction brace. RESULTS: The patient shown in Figures 26 through 29 and Video 5 was a three-year and six-month-old girl with bilateral developmental dysplasia of the hip that was discovered late (Figs. 26 and 27).IndicationsContraindicationsPitfalls & Challenges.
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