ABSTRACT
OBJECTIVE: Cases of developmental dislocation of the hip (DDH) still occur after walking age because of late or missed diagnosis and failed conservative treatment. The choice of treatment for DDH after walking age continues to be controversial, and one of the options is open reduction combined with innominate osteotomy. METHODS: Twenty patients with 26 surgically treated hips with DDH, were evaluated from 2005 to 2008, using innominate osteotomy by Salter's technique after open reduction and capsulorraphy. The age of patients, fifteen females and five males, at time of surgery ranged from 12 to 18 months (mean age 14.7 months). Six patients had bilateral dislocation and in the remaining, nine had their left hip dislocated and five had their right hip dislocated. RESULTS: The results were evaluated according to modified McKay criteria and to Severin radiological criteria, after a mean follow-up of 46.7 months. Eighty - nine percent of hips were rated as excellent or good by McKay criteria. There were no poor results. According to Severin criteria, 77% were type I and II while 23% showed type III and IV, no hips were rated as Severin's group V or VI. There was one case (3.8%) of re-dislocation, but revision surgery resulted in stable, concentric, and permanent reduction. No cases of infection, graft fracture and vascular or nervous injury were reported. CONCLUSION: Open reduction combined with Salter osteotomy does not hurt the hip with regard to acetabular remodeling for children between 12 and 18 months of age. Level of Evidence IV, Case Series.
ABSTRACT
OBJETIVO: Os casos de displasia de desenvolvimento do quadril (DDQ) ainda ocorrem depois da idade da marcha devido ao diagnóstico tardio ou ausente e à falha do tratamento conservador. A escolha do tratamento da DDQ depois da idade da marcha continua controversa e uma das opções é a redução a céu aberto combinada com osteotomia do inominado.MÉTODOS: Vinte pacientes com 26 quadris com DDQ tratados cirurgicamente foram avaliados de 2005 a 2008, usando-se a osteotomia do inominado pela técnica de Salter depois de redução e capsulorrafia a céu aberto. A idade dos pacientes no momento da cirurgia variou de 12 a 18 meses (média de idade 14,7 meses). De 15 pacientes do sexo feminino e cinco do masculino, seis tiveram luxação bilateral e dos restantes, nove tiveram luxação do quadril esquerdo e cinco, do direito.RESULTADOS: Os resultados foram avaliados de acordo com os critérios modificados de McKay e dos critérios radiológico de Severin, depois de acompanhamento médio de 46,7 meses. Oitenta e nove por cento dos quadris foram classificados como excelentes ou bons pelos critérios de McKay. Não houve resultados ruins. De acordo com os critérios de Severin, 77% eram do tipo I e II, enquanto 23% eram do tipo III e IV; nenhum quadril foi classificado nos tipos V ou VI. Houve um caso (3,8%) de reluxação, mas a cirurgia de revisão resultou em redução estável, concêntrica e permanente. Não há relato de casos de infecções, fratura do enxerto e lesão vacular ou nervosa.CONCLUSÃO: A redução a céu aberto combinada com a osteotomia de Salter não afeta o quadril com relação à remodelação em crianças entre 12 e 18 meses de idade. Nível de Evidência IV, Série de Casos.
OBJECTIVE: Cases of developmental dislocation of the hip (DDH) still occur after walking age because of late or missed diagnosis and failed conservative treatment. The choice of treatment for DDH after walking age continues to be controversial, and one of the options is open reduction combined with innominate osteotomy.METHODS: Twenty patients with 26 surgically treated hips with DDH, were evaluated from 2005 to 2008, using innominate osteotomy by Salter's technique after open reduction and capsulorraphy. The age of patients, fifteen females and five males, at time of surgery ranged from 12 to 18 months (mean age 14.7 months). Six patients had bilateral dislocation and in the remaining, nine had their left hip dislocated and five had their right hip dislocated.RESULTS: The results were evaluated according to modified McKay criteria and to Severin radiological criteria, after a mean follow-up of 46.7 months. Eighty nine percent of hips were rated as excellent or good by McKay criteria. There were no poor results. According to Severin criteria, 77% were type I and II while 23% showed type III and IV, no hips were rated as Severin's group V or VI. There was one case (3.8%) of re-dislocation, but revision surgery resulted in stable, concentric, and permanent reduction. No cases of infection, graft fracture and vascular or nervous injury were reported.CONCLUSION: Open reduction combined with Salter osteotomy does not hurt the hip with regard to acetabular remodeling for children between 12 and 18 months of age. Level of Evidence IV, Case Series.