TITLE:
Congenital Dislocation of the Hip in Children between the Ages of One and Three: Open Reduction and Modified Salter Innominate Osteotomy Combined with Fibular Allograft
AUTHORS:
Nguyen Ngoc Hung
KEYWORDS:
Hip Dysplasia; Innominate Osteotomy; Congenital Dislocation of the Hip; Development Dysplasia of the Hip; Allograft
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.3 No.2,
June
7,
2013
ABSTRACT:
Background: Innominate osteotomy procedures have been widely used
as an integral component of combined surgery to treat developmental dysplasia
of the hip in children. Autograft concern is further supported by authors who
suggest the routine use of internal fixation. Problems such as graft extrusion,
rotation and absorption, leading to loss of acetabular correction, were often
noted in cases previously treated at our National Hospital for Pediatrics. This
retrospective study reviewed the radiographic results of this treatment
protocol in 106 hips developmental dislocated hips which met our inclusion
criteria. The efficacy of this method to achieve and maintain a well covered
and stable hip was the main objective of the study. Methods: This
retrospective study reviewed the radiographs of 106 hips presenting with developmental dislocation which were
treated by modified Salter’s innomiate osteotomy and using a fibular allograft
as the interposition material. Dislocations of the hip were graded using the
T?nnis system. Measurement of the acetabular index (AI) was the main variable.
The minimum follow up period was 2 years.
Possible complications such as loss of acetabular correction, hip redislocation,
graft extrusion or resorption, the need for osteotomy internal fixation,
delayed or non union, infection or avascular necrosis (AVN)
were documented in this series. Results: Between January 2004 and December
2008, 106 surgeries were performed in 95 patients. Sixty-three (86.3%) of the patients were girls and
ten (13.7%) were boys, thirteen
patients (13.7%) were between twelve and eighteen months old at the time of the
operation, the remaining eighty-two (86.3%)
patients being between eighteen and thirty-six months old, with the mean age of 22.6 months at the time of surgery. There were eleven (11.6%) patients who had bilateral dislocation. Eighty-four
(88.4%) patients were affected unilaterally. The right hip was involved in
seventeen (17.9%) and the left hip in sixty-seven (70.5%) cases. T?nnis system Type 3 was in 34 hip (32.1%),
and Type 4 was in 72 hip
(67.9%). All patients combined open reduction and modified Salter’s innomiate
osteotomy, inserting a fibular allograft as the interposition material. Acetabular index was improved, preoperation was 42.95°, and latest follow-up 19.15°, concentrical acetabulum 93.7%. All
of the fibulat allografts were completely incorporated mean 14 weeks (range, 12
weeks - 17 weeks) post-surgery. There were five (4.7%) redislocation and
subluxation, three AVN (2.8%) and five (4.7%) coxa magna Without graft infections,
none of the osteotomies required internal fixation for stability. Final results: Excellent 70 (66.0%),
Good 29 (27.4%), Fair 2 (1.9%),
Poor 5 (4.7%). Conclusion: Open reduction and modified Salter’s innomiate osteotomy allow
interposition material by fibular allografting with a short operative incision,
renders excellent osteotomy
stability that eliminates the need for internal fixation. Surgical technique
are safe and effective for Children
between twelve and thirty-six
months old.