Proposal of a novel predictive radiological method to assess the possibility of closed reduction in late presenting developmental dysplasia of the hip: the femoro-acetabular zones.

Late presentation of developmental dysplasia of the hip (DDH) remains a major orthopedic problem. However, existing management is not standardized and is highly surgeon dependent. The theory behind femoro-acetabular zones (FAZ) system is to find a relationship between acetabular maturity and severity of dislocation in one hand, and the outcome of closed reduction, on the other hand in late presenting cases. A retrospective study was performed on children with untreated DDH that underwent closed treatment. Our series consisted of 65 hips; mean patient age was 24 months (range: 9-30 months) with a minimum follow-up of 3 years. FAZ classification was applied to the pre-reduction pelvic radiograph, while the results were evaluated according to Severin's scoring system. Overall, 37 of 65 hips (57%) achieved a satisfactory outcome (Severin I and II), while 22 hips (33%) were found to be unsatisfactory (Severin III). Six hips (10%) needed an open reduction. FAZ expressed a simple and reliable classification in predicting the success of closed reduction. This novel X-ray-based classification system can easily predict patients with DDH in whom a closed reduction is likely to succeed and defer patients with higher grades to surgical intervention. Yet, its validity has to be verified in larger cohort studies and directly compared to the established International Hip Dysplasia Institute classification.

A Rare Case of Ipsilateral Floating Hip with Femoral Neck Fracture and Contralateral Floating Knee Injury - Proposal for a Management Flowchart and Literature Review.

INTRODUCTION: Femoral neck fractures can complicate by non-union and/or hip avascular necrosis (AVN); moreover, the incidence of AVN remains obscure when it is accompanied by an ipsilateral acetabular fracture. Measures to reduce non-union or hip AVN with this complex injury pattern are not well addressed in the literature. CASE REPORT: We report a case of a young male patient who sustained ipsilateral acetabular, femoral neck, and shaft fractures in addition to a contralateral floating knee injury following a motor vehicle collision. To the best of our knowledge, this is the first report that describes the simultaneous occurrence of these fractures and their management. The patient attained an excellent functional outcome with union of all his fractures. We, therefore, propose a management flowchart for this rare case scenario. CONCLUSION: The acute management of ipsilateral femoral shaft and neck fractures in such cases has to be prioritized. The use of a retrograde nail in addition to dynamic hip screw (DHS) with two cannulated anti-rotation screws and locking the DHS to the nail is likely to increase the healing potential of femoral neck fracture in these cases. Acetabular fixation is better to be performed in a second stage after the hyper-inflammation phase ends. The definitive management for the contralateral floating knee can be delayed to a third stage but should be completed within the 10-day limit of immunosuppression.