Effect on mortality of treatment method and surgery time for hip fracture patients aged over 65 years.

BACKGROUND: This study aimed to evaluate the effects on mortality of implant selection used and time to surgery in patients aged over 65 years operated for hip fractures. METHODS: A total of 301 patients aged over 65 years were investigated in this study. Patients were divided into three groups as follows: Group 1 cemented hemiarthroplasty (CH), Group 2 cementless hemiarthroplasty (CLH), and Group 3 proximal femoral nail (PFN). Time of surgery, fracture and demographic information were retrospectively recorded. RESULTS: After removing 59 patients with missing information, this study included 242 patients. Mean age of patients was 80.5 years. When patient groups were examined according to treatment method, Group 1 (n=146) comprised 60.3%, Group 2 (n=54) comprised 22.3% and Group 3 (n=42) comprised 17.4% of the study group. There was no significant difference in survival between the patients operated in the first 48 hours and the patients operated later (p=0.834). There was an effect on the survival of treatment implant selection (p=0.016). Patients with CH were observed to survive longer than patients with CLH and PFN. CONCLUSION: Operation in the first 48 hours was not observed to affect mortality. Additionally, while sex and age were found to be effective on mortality, implant selection was also concluded to affect mortality.

Investigation of mechanical strength of teicoplanin and ciprofloxacin impregnated bone cement on Day 1 and Day 15.

OBJECTIVE: The aim of this study was to compare the mechanical effects of different concentrations of teicoplanin and ciprofloxacin addition in bone cement. METHODS: In an experimental design, 3 different doses of teicoplanin and ciprofloxacin (800, 1600 and 3200 mg) were added to bone cement. Mechanical tests using compression and four-point bending tests were performed on Day 1 and after antibiotic leaching in water at 37°C on Day 15. Specimens that contained no antibiotics served as controls. Mechanical strength for each antibiotic concentration on Day 1 and Day 15 were evaluated. RESULTS: Both teicoplanin and ciprofloxacin significantly decreased the mean strength values in compression and four-point bending tests at Days 1 and 15 (p<0.05). While teicoplanin significantly decreased the mean strength values at high doses in both tests at Days 1 and 15 (p<0.05), ciprofloxacin did not significantly change these values. When the effects of two drugs compared, there were significant differences at the 3200 mg dose at Day 1 and at 1600 and 3200 mg doses at Day 15 in the compression testing and at 3200 mg at Day 15 in the four-point bending test. CONCLUSION: Teicoplanin and ciprofloxacin addition may adversely affect the biomechanical strength of bone cement. Ciprofloxacin addition seems to have less of a negative effect on strength than teicoplanin.

Arthroscopic-assisted surgical treatment for developmental dislocation of the hip before the age of 18 months.

PURPOSE: The purpose of this study is to evaluate the results of arthroscopy assisted surgical treatment of developmental dislocation of the hip (DDH). METHODS: Arthroscopic assisted surgical treatment was performed on nine hips of nine female children with DDH using our method, published previously, between January 2001 and December 2005. Their ages ranged from 9 to 16 months. Percutaneous adductor tenotomies were performed in seven cases. A spica cast and abduction splint were used for 11-17 weeks postoperatively. Acetabular index and Shenton line were used for preoperative and postoperative radiologic evaluation. Also, the cases were evaluated postoperatively with respect to range of motion restriction, and the leg length discrepancy. RESULTS: The average follow-up was 47.7 months (range 22-79 months). Acetabular index measurements of cases in the preoperative/postoperative periods were as follows: preoperative mean angle 39.9° (range 34°-52°)/postoperative mean angle 26° (range 22°-34°). Hip joint restriction and leg length discrepancy were not observed postoperatively. However, two patients had acetabular dysplasia. Acetabular dysplasia was completely resolved in one patient in the third year of follow-up, whereas Salter innominate osteotomy, required in another patient, was in the second year of follow-up. The latter patient was the oldest case (16-month-old) in our series. CONCLUSIONS: Based on the results of this study, treatment of developmental hip dysplasia with arthroscopic-assisted surgical treatment technique may be safe and effective method. Further clinical studies will be required to confirm this study.

Biomechanical properties of ciprofloxacin loaded bone cement.

OBJECTIVE: The purpose of this study was to investigate the biomechanical properties of bone cement used in joint replacement surgery after the addition of ciprofloxacin. METHODS: The first group received bone cement only and served as a control for the 4 groups where 500 mg, 1000 mg, 1500 mg and 2000 mg of ciprofloxacin were added to yield 40 g of bone cement. Axial compression tests were conducted using a 50,000 Newton capacity tension-compression testing device. RESULTS: While axial compression strength at failure was 80.2±4.3 MPa in the control group, values in the ciprofloxacin-treated groups decreased with rising concentration of ciprofloxacin to 74.5±5.4 MPa, 70.6±4.8 MPa, 70.5±4.7 MPa, and 69.3±3.4 MPa. CONCLUSION: Bone cement with addition of 500 to 1500 mg ciprofloxacin maintained mechanical axial strength values above 70.0 MPa recommended by American Society for Testing and Materials and can be safely used in joint replacement surgery.

[Radiation synovectomy therapy combined with surgical synovectomy in chronic nonspecific synovitis of the knee joint]. / Diz ekleminin kronik nonspesifik sinovitlerinde cerrahi sinovektomi ile kombine radyasyon sinovektomi tedavisi.

OBJECTIVES: This study aims to investigate the effectiveness of the radiation synovectomy (RS) procedure combined with the surgical synovectomy in the treatment of chronic nonspecific synovitis, which are resistant to medical treatment. PATIENTS AND METHODS: Between March 2004 and October 2009, 17 knees of the 17 patients (15 males, 2 females; mean age 42.5 years; range 27 to 70 years) who underwent synovectomy surgery, followed by RS procedure with the 90Y at six weeks were included. At the end of a mean 48.7 months (range; 15-126 months) follow-up period, the Lysholm Knee Scale scores were used for functional assessment before and after RS procedure. The nocturnal pain, resting pain, activity pain and effusion were evaluated with the visual analog scale. The patient satisfaction was recorded as excellent, very good, good and poor. RESULTS: At the end of the follow-up period, all patients had satisfaction scores of excellent and very good. There was a statistically significant difference between all assessment scores before and after treatment (p<0.05). It was found that none of the cases had radionuclide leakage from the joint in their control scintigraphy following RS procedure. No significant complication was seen except for deep vein thrombosis developed in one case. CONCLUSION: Our study results showed that RS procedure combined with the surgical synovectomy is an effective and safe treatment method for the treatment of cases of chronic nonspecific synovitis which recurs despite medical treatment.

Surgical synovectomy combined with yttrium 90 in patients with recurrent joint synovitis.

Radiation synovectomy (RS) is one of many therapeutic options used for recurrent joint synovitis. Our aim was to analyze the effect of the surgical synovectomy combined with yttrium 90 ((90)Y) in the treatment for recurrent joint synovitis. A surgical combined RS procedure was used on 32 knees of 30 patients. They were divided into two groups. Group 1 consisted of 7 knees of 7 patients (5 women and 2 men) with a mean age of 40.7 years in whom RS was combined with the open synovectomy. Group 2 consisted of 25 knees of 23 patients (21 men and 2 women) with a mean age of 45.5 years in whom RS was combined with the arthroscopic synovectomy. Arthroscopic synovectomy or open surgery biopsy was carried out for all cases who diagnosed of having synovitis. A scintigraphic examination was conducted within 24 h after the RS procedure to investigate the systemic leakage of (90)Y in all patients. The outcome of treatment was assessed based on self-reporting using the visual analogue scale (VAS) of night pain, rest pain, activity pain, effusion, and satisfactory scores. The average follow-up period was 4.15 years. There was a significant difference between before and after treatment in terms of outcome parameters' VAS scores in both groups (p < 0.05). But there was no statistically significant difference between open and arthroscopic synovectomy groups in terms of outcome parameters (p > 0.05). Satisfactory outcome was excellent in 3 patients (42.8 %) in group 1 and 8 patients (32 %) in group 2. Surgical synovectomy with combined (90)Y could treat recurrent joint synovitis successfully. There was no statistically significant difference between open and arthroscopic synovectomy techniques combined with RS procedure.

Evaluation of urinary bladder function after acute spinal cord injury: an experimental study.

OBJECTIVES: The aim of this study was to evaluate the efficacy of early surgical decompression of acute spinal cord injury through the evaluation of urinary bladder function in rabbits. MATERIALS AND METHODS: The study was done with 21 New Zealand male rabbits which were 9 to 12 months in age, and weighed an average of 2438 grams (range 2150 to 3550 g). The animals were assigned into four groups as follows: a control group (n=5), a laminectomy group (n=6), a 15-second compression group (n=5) and a 60-second compression group (n=5). A 60 gram compression force was applied on both compression groups with aneurysm clips. All rabbits were sacrificed seven days postoperatively. Urinary bladder tissues were dissected and in vitro relaxation and contraction tests were performed in organ baths. RESULTS: At the beginning of each experiment, 80 mM KCl was added to the isolated organ bath with no significant difference among all four groups (p>0.05). Carbachol was then added to the organ bath and contraction responses were obtained. Carbachol contraction responses were calculated as the percentage of the 80 mM KCl contraction responses, with compression groups showing significant difference from control and sham-operated groups (p<0.05). Electrical field stimulation responses were obtained for all group preparations at 4, 8, 16, 32 Hz frequencies, and showed significant difference in the 15 and 60-second compression groups (p<0.05). The contractility was assessed using E-max and pD2 values. All groups exhibited same pD2 values. CONCLUSION: The study demonstrated a slightly better outcome for bladder contractility with early decompression. However, there was no significant difference between early and delayed decompression groups.

Long segment instrumentation of thoracolumbar burst fracture: fusion versus nonfusion.

OBJECTIVE: The treatment of thoracolumbar burst fracture is a controversial issue. Although spinal fusion has been a touchstone of spinal fixation, nonfusion technique have become raising its popularity recently. Some studies suggested that nonfusion had several advantages over fusion. The aim of this prospective study was to compare long segment posterior instrumentation with fusion versus long-segment posterior instrumentation without fusion. METHODS: For this purpose, 42 consecutive patients were assigned to two groups. Group 1 included 21 patients treated by long segment instrumentation with fusion (WF), whereas Group 2 included 21 patients treated by long segment instrumentation without fusion (WOF). Long segment instrumentation was hook fixation (claw hooks attached to second upper vertebra and infralaminar hooks attached to first upper vertebra) above and pedicle fixation (pedicle screws attached to first and second lower vertebrae) below the fractured vertebra. RESULTS: Measurements of local kyphosis, sagittal index and anterior vertebral height compression showed that both group had similar outcome at final follow-up. Moreover, there was no difference between the two groups according to low back outcome score. Also, implant failure rate (4.7%) was quite low in both groups. However, WF group had prolonged operative time, increased blood loss and donor site morbidity. CONCLUSIONS: Radiological and clinical parameters demonstrated that spinal fusion is not necessary in long segment posterior instrumentation for the management of thoracolumbar burst fractures.

[School screening for scoliosis in Sivas, Turkey]. / Sivas il merkezinde skolyoz için okul taramasi.

OBJECTIVES: We investigated the prevalence of scoliosis among primary school students in Sivas, Turkey. METHODS: To determine the prevalence of scoliosis among primary school students in the age bracket of 10 to 15 years, 11 primary schools were selected with systematic sampling. A total of 3,175 students (1,538 girls, 1,637 boys) of grades 6 to 8 were selected from 16,103 students using a stratified sampling method. Examination for scoliosis was made by the forward bend test and palpation of the spine. RESULTS: Fifteen children (0.47%) were found to have scoliosis, including 10 girls (66.7%) and five boys (33.3%). The prevalence of scoliosis was significantly higher in girls (0.65% vs. 0.31%; p<0.05). The mean lateral curvature of the spine was 6.9 degrees (range 5 degrees to 20 degrees ), being 7.9 + or - 4.6 degrees in girls, and 5.4 + or - 0.9 degrees in boys. The mean age was 13.5 + or - 1.2 years (range 12-15 years). The severity of the curvature showed no significant relationship with gender and age groups (p>0.05). The levels of involvement were lumbar vertebrae in 73.3% (n=11), thoracic vertebrae in 13.3% (n=2), and thoracolumbar vertebrae in 13.3% (n=2). Spinal curvature was to the right side in 12 cases (80%), and to the left in three cases (20%). Girls and boys did not differ significantly with respect to the severity and direction of the curvature (p>0.05). During a two-year follow-up of children with scoliosis, no progression of the curvature was observed, including one child who wore a Milwaukee brace. CONCLUSION: School screenings may be performed as part of prevalence studies; however, routine school screening for scoliosis is debatable.

[Comparison of three fixation methods in transverse fractures of the patella in a calf model]. / Dana modelinde transvers patella kiriklarinda üç farkli tespit yönteminin karsilastirilmasi.

OBJECTIVES: We evaluated the strength of three different fixation methods against distraction forces in a transverse fracture model of calf patellae. METHODS: Thirty calf patellae were randomly divided into three groups equal in number. Transverse fractures were induced at the same localization in all the samples. The fractures were fixed with a modified anterior tension band technique, Acutrak 4/5 screws, and a combination of Acutrak 4/5 screws and tension band technique in three groups, respectively. Following fixation, each patella was mounted in a compression-distraction testing machine from the quadriceps and patellar tendons on each side of the patella, and equal distraction forces were applied to each patella. The average load to failure at the fracture site was calculated and the results were compared with the Friedman test. RESULTS: The mean failure loads were significantly different in three groups, being 288.8+/-40.1 newton (N), 878.5+/-68.6 N, and 938.6+/-38.8 N, respectively (p<0.001). The most efficient stabilization was obtained in the third group in which Acutrak 4/5 screws and the tension band application were used in combination, while the modified anterior tension band technique alone was found to be the weakest fixation technique. CONCLUSION: Our results showed that Acutrak 4/5 screws enabled a rigid fixation in the surgical treatment of patellar fractures.

Use of ultrasound for diagnosis of interposition of soft tissue in bone fracture line.

Ultrasound (US) has recently become a favorable diagnostic technique in orthopedics and traumatology, as well as in other medical sciences. We aimed to determine effectiveness of US in diagnosis of soft tissue interposition that impedes or delays the union of fracture. The present study included 55 acute fractures in 39 patients, in whom operation (open reduction and internal fixation) was scheduled because no closed reduction was achieved, in our department between January 1999 and December 2003. Before the operation, the fracture line in all patients was scanned by a 5- to 7-MHz linear probe of the US device. The data obtained by US examination were compared to findings obtained by surgical intervention with the McNemar test. These were calculated as positive predictive value and negative predictive value, with specificity and sensitivity. The difference between the study and control groups was not statistically significant (p = 0.625). These findings demonstrated that sensitivity value, specificity value, positive and negative predictive values were 96.9%, 86.3%, 91.4% and 95%, respectively. US is an efficient, safe and reliable diagnostic technique for detection of interposition of soft tissue in bone fracture line.

Augmentation vs Nonaugmentation Techniques for Open Repairs of Achilles Tendon Ruptures with Early Functional Treatment: A Prospective Randomized Study.

A prospective randomized study was conducted in order to compare augmentation technique versus nonaugmentation technique, followed by early functional postoperative treatment, for operative repair of Achilles tendon ruptures. Twenty-four consecutive patients were assigned to two groups. Group I included 12 patients treated with Lindholm augmentation technique, whereas group II included 12 patients treated with modified Kessler end-to-end repair. Thereafter, these patients had postoperative management with a below-knee-cast for three weeks. The physioteraphy was initiated immediately after the cast was removed. Full weight bearing was allowed after five weeks postoperatively in the both groups. Two patients had reruptures in group II, whereas group I had prolonged operative time significantly. The patients with reruptures underwent reoperations and at the most final follow-up, it was observed that they could not resume to sporting activities. The other objective and subjective results were similar between two groups. Because of quite high rerupture rate in the group of patients treated with nonaugmentation technique, we favor functional postoperative treatment with early ankle movement in the patients treated with augmentation technique for the management of acute rupture of the Achilles tendon. Key PointsA prospective randomized study was conducted in order to compare augmentation technique versus nonaugmentation technique, followed by early functional postoperative treatment, for operative repair of Achilles tendon ruptures.Group I included 12 patients treated with Lindholm augmentation technique, whereas group II included 12 patients treated with modified Kessler end-to-end repair.Functional postoperative treatment with early ankle movement in the patients treated with augmentation for the management of acute rupture of the Achilles tendon is recommended.

Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation.

OBJECTIVE: The treatment of thoracolumbar burst fracture is a controversial issue. Short-segment (SS) pedicle fixation has become a popular treatment option. However, there are several studies regarding the high rate of failure. The aim of this prospective study was to compare SS versus long-segment (LS) instrumentation. METHODS: For this purpose, 18 consecutive patients were assigned to two groups. Group 1 included nine patients treated by SS pedicle fixation, whereas group 2 included nine patients treated by LS instrumentation. SS instrumentation was pedicle fixation one level above and below the fractured vertebra. LS instrumentation was hook fixation (claw hooks attached to second upper vertebra and infralaminar hooks attached to first upper vertebra) above and pedicle fixation (pedicle screws attached to first and second lower vertebrae) below the fractured vertebra. RESULTS: As a result, measurements of local kyphosis, sagittal index, and anterior vertebral height compression showed that the LS group had a better outcome at final follow-up (P < 0.05). Also, the SS group had a 55% failure rate, whereas the LS group had prolonged operative time and increased blood loss. However, there was no difference between the two groups according to Low Back Outcome Score. CONCLUSIONS: In conclusion, radiographic parameters demonstrated that LS instrumentation is a more effective management of thoracolumbar burst fractures. Nevertheless, clinical outcome was the same between the two groups. However, our conclusions were based on posterior-only surgery. Anterior column support would negate the need for LS fixation. Also, SS would have been more successful if two above and two below pedicle screws were used.

Aseptic necrosis of the hamate: a case report.

The case of a 25-year-old man with osteonecrosis of the hamate is reported. He had pain and swelling in his right wrist. The diagnosis was accomplished with plain radiographs as well as with MRI. The case was treated surgically that included resection of the necrotic bone. The occured cavity was filled with autogenous cancellous bone graft. In addition, capito-hamate arthrodesis was performed. Histopathological examination following the operation demonstrated avascular necrosis of the hamate. The arthrodesis was obtained four months after the operation.

Arthroscopic-assisted surgical treatment for developmental dislocation of the hip.

PURPOSE: Treatment of developmental dislocation of the hip (DDH) includes surgical management in older children or in those who cannot be treated conservatively. However, complication rates of surgical treatment are quite high. The purpose of this report is to introduce our new surgical technique that can eliminate existing pathologic changes in DDH. TYPE OF STUDY: A small case series. METHODS: We performed arthroscopic-assisted surgical treatment in 4 hips of 4 female children who had DDH and no previous treatment. Their ages ranged from 11 to 14 months. Closed reduction under general anesthesia was tried just before the surgical intervention, but it failed in all of them. Tightness of the iliopsoas tendon was released followed by dissection of capsular adhesions using an anterolateral mini-incision. Excision of the hypertrophic ligamentum teres, transverse acetabular ligament, and pulvinar tissue was carried out using a double-portal arthroscopic procedure. We performed percutaneus adductor tenotomies in 2 cases. A spica cast and abduction splint were used for 12 to 17 weeks postoperatively. The follow-up of the patients was a minimum of 1 year. Although a 1-year follow-up period is adequate to evaluate the short-term results, it has been considered that there is a need for further studies that include long-term follow-up. We used the acetabular index and Shenton's line for preoperative and postoperative radiologic evaluation. Also, the cases were evaluated postoperatively in respect to range of motion restriction and the leg length discrepancy. RESULTS: The mean follow-up was 13.7 months (range, 12 to 16 months). Acetabular index measurements of the cases in the preoperative/postoperative periods were as follows: in the first case, 34 degrees/27 degrees; in the second case, 35 degrees/22 degrees; in the third case, 52 degrees/39 degrees; and in the fourth case, 40 degrees/28 degrees. Hip joint restriction and leg length discrepancy were not observed postoperatively. CONCLUSIONS: All the intra-articular structures (hypertrophic ligamentum teres, transverse acetabular ligament, and pulvinar tissue) in the acetabulum that impede the reduction of the femoral head have been eliminated by using the arthroscopic technique. The arthroscopic-assisted surgical treatment of DDH is successful in the short-term follow-up period. LEVEL OF EVIDENCE: Level IV, Case Series.

Indirect spinal canal decompression of vertebral burst fracture in calf model.

INTRODUCTION: An experimental study of experimental burst fractures in bovine spinal specimens was conducted to analyze the effects of transpedicular short-segment posterior fixation followed by reduction on indirect spinal canal decompression. MATERIALS AND METHODS: For this purpose, experimental burst fractures were created in 11 bovine specimens with a hydraulic materials-testing machine. The specimens were evaluated with plain radiographs and CT scans before reduction. Thereafter, they were instrumented with titanium transpedicular screws and rods (short-segment posterior fixation); and reduction was achieved which included distraction and kyphosis correction maneuvers. RESULTS: Each spinal specimen was evaluated with plain radiographs and CT scans after reduction by applying distraction and kyphosis correction maneuvers. Plain radiographic analysis showed that the kyphosis angle and segmental height values improved. Furthermore, CT scans revealed that the spinal canal diameter values improved compared with those before reduction. The differences between before and after reduction in kyphosis angle, segmental height, anterior body compression, and percentage of retropulsion were statistically significant. CONCLUSION: Short-segment posterior fixation followed by indirect spinal canal decompression led to an improvement over spinal canal retropulsion in experimental burst fractures. Furthermore, the kyphosis angle and segmental height values improved following the reduction compared with those before reduction.

Doping and performance enhancing drug use in athletes living in sivas, mid-anatolia: a brief report.

The aim of this study was to determine the rate of doping and performance enhancing drug use in athletes in Sivas, Turkey, and to analyze the main reasons for the use. This was a cross-sectional study based on a self-report questionnaire. The subjects filled the questionnaires under the supervision of the investigators during interviews. This questionnaire included 24 items describing the population in terms of demographics, sport practice, doping in sport and substance use. Moreover, we assessed the frequency of doping drug use. The number of respondents was 883, of which 433 athletes and 450 healthy non-athletes (control group). The mean age of the total volunteers was 21.8 ± 3.7 yrs. The male and female ratios were 78.2% and 21.8% respectively. Doping and performance enhancing drug usage rate was 8.0% (71cases in 883 subjects). Doping drug use among the athletes was significantly (p < 0.05) higher (14.5%) compared with the non-athletes (1.8%). The agents used were anabolic steroids in 60.5%, l-carnitene in 12.7%, erythropoietin in 5.4%, Na-bicarbonate in 11.3% and creatinine in 14.1% of 71 cases. The reasons for doping use were to have a better body condition in 34 cases (47.9%) and to solve weight (gaining or loosing) problems in 8 (11.3%) cases. Since the potential side effects of doping drugs are not satisfactorily familiar to the most users, the education of athletes on the matter must be a top priority. Key PointsDoping and performance enhancing drug use was 71 (8.0%) in 883 subjects, and it was significantly higher (14.5%) in the athletes compared with the non-athletes (1.8%) in Sivas, Turkey.The rate of athletes who experienced such drugs at least once in their life was 29.0%.The 52.4% of doping and performance enhancing drug users accepted that they were unaware of the drugs full and/or potential side effects.

The rolling belts injuries in childhood.

Rolling belt injuries are commonly seen in the summer when the tractors and water pumps work in agricultural fields. These machines' rolling belts may attract children and entrap their hands. The injuries frequently affect soft tissues and bone of volar side of their hands. Amputations may be seen. In the present study, 45 patients with rolling belt injuries were retrospectively analysed. It was observed that 133 fingers of 42 patients and three hands (Zone III) of three patients were surgically treated. The treatment included primary closure of the lacerations, tendon/nerve repair, fixation of fractures, grafting, and local or cross-arm or groin flaps. Stump closure procedures were performed in 21 fingers with total amputations or non-viable tissues. The injuries in most of the cases were localised at Zones I and II. We performed revascularisation procedures in five fingers. Only one of them stayed alive (20%). Our results revealed that 13 cases were good, 21 were fair and 11 were poor to according to Gorsche and Wood criteria. These injuries cause the burns and defects on digital arteries-veins as well as flexor tendons. Frequently, phalanx fractures and finger amputations may occur. Also, the skin defects are common. The treatment of rolling belt injuries is difficult, quite expensive, and the outcomes are not always satisfactory.

The surgical treatment of developmental dislocation of the hip in older children: a comparative study.

The aim of this retrospective study was to compare simultaneous open reduction and Salter innominate osteotomy versus one-stage combined surgical treatment including femoral shortening. A total of 24 patients were studied. Group 1 included 16 hips in 14 patients treated by simultaneous open reduction and Salter innominate osteotomy; Group 2 included 13 hips in 10 patients treated by one-stage open reduction, Salter innominate osteotomy and femoral shortening. The average age at the time of operation was 4.1 years (range: 3.3 to 5.1). Average follow-up was 5.3 years (range: 2.7 to 9.0). Clinical and radiological assessment at final follow-up showed that the outcome was not significantly different between the two groups. The duration of operation, however, was significant different between the groups. Patients with DDH between 3 and 5 years of age were treated successfully with either simultaneous open reduction and Salter innominate osteotomy or a one-stage combined surgical procedure including femoral shortening. Clinical and radiological outcomes were similar. Nevertheless, after this follow-up period, the rate of avascular necrosis was slightly higher in Group 1; on the other hand, one-stage combined surgical treatment including femoral shortening significantly prolonged the operative time.