Double-Level Pelvic Osteotomy for Managing Persistent Acetabular Dysplasia.

Pemberton's osteotomy has been recognized as a standard technique for the treatment of acetabular dysplasia. The aim of this article is to describe the surgical technique of a double-level pelvic osteotomy. To the authors' knowledge, this technique has never been reported. The osteotomy was performed in a case of severe pan-acetabular dysplasia where a single, classic Pemberton's osteotomy was not sufficient to provide adequate coverage. The described osteotomy provided sufficient acetabular coverage and overcame the persistent acetabular dysplasia. [Orthopedics. 2016; 39(4):e806-e809.].

The early detection and management of unstable concentric closed reduction of DDH with percutaneous K-wire fixation in infants 6 to 12 months of age.

BACKGROUND: In some infants with developmental dysplasia of the hip, concentric closed reduction, although initially achievable, cannot be maintained even by casting because of a deficient posterior acetabular wall. Usually, these hips will redislocate in the cast and a rereduction will be necessary, often requiring an open reduction subsequently. METHODS: A 3-year retrospective review of 88 infants, (M/F; 14/74) 6 to 12 months of age with 124 dislocated hips, was conducted to assess the efficacy of percutaneous Kirschner wire fixation in achieving permanent hip stability. A "hip-at-risk" instability test was developed to detect potentially unstable hips at the time of closed reduction that might redislocate in the hip spica cast, and these hips were stabilized with a percutaneous K-wire through the greater trochanter into the pelvic bone. RESULTS: The hip instability test was positive in 27 hips and negative in 97. Percutaneous K-wire fixation was used to stabilize 21 hips with a positive hip instability test. All 21 unstable hips that were stabilized with the K-wire technique maintained their concentric reduction and went on to stable development. No K-wire breakage was encountered and only 1 superficial pin tract infection occurred. CONCLUSIONS: K-wire stabilization of unstable closed reductions is a safe, reliable technique for maintaining concentric hip reduction in infants 6 to 12 months of age with developmental dislocation of the hips. LEVEL OF EVIDENCE: Level II retrospective study.

Acetabular cartilaginous angle: a new method for predicting acetabular development in developmental dysplasia of the hip in children between 2 and 18 months of age.

BACKGROUND: A new method of arthrographic measurement, the acetabular cartilaginous angle (ACA), is described here in an effort to find a simple, reliable, and reproducible measurement that can predict future acetabular development after successful closed reduction of developmental dysplasia of the hip (DDH). METHODS: A prospective study was conducted for children with DDH who were treated successfully by closed reduction in the authors' institute from 1994 through 2000. The total number of patients who completed the follow-up in our study until full acetabular development or acetabuloplasty was 162, with 234 affected hips. Their age at the time of closed reduction ranged between 2 and 18 months (mean, 7.48 months; SD +/-5.162). There were 135 girls and 27 boys. Frank dislocation of the hip was present in 195 hips, whereas acetabular dysplasia with or without lateralization of the femoral head was seen in 39 hips. The average follow-up was 9.2 years (range, 6-11 years). RESULTS: Multivariate analysis of 6 variables showed that the mean age and acetabular index at the time of closed reduction were significant to predict later acetabuloplasty, whereas ACA was highly significant. These 3 significant variables together had 96.58% correct prediction. The authors observed that some hips with high acetabular index developed satisfactorily, and other hips with small values required later acetabuloplasties. On the other hand, there was a clear cut value of ACA (20 degrees) under which almost all hips (99.5%) developed satisfactorily and another clear cut value of ACA (24 degrees) above which all hips (100%) needed acetabuloplasty. CONCLUSIONS: Acetabular cartilaginous angle is considered a reliable measurement to identify hips with DDH that will need later acetabuloplasty after successful closed reduction. The acetabular index is important in monitoring acetabular development, and reaching a value of less than 30 degrees 2 years after closed reduction is considered a good sign of acetabular development.

The role of arthrography-guided closed reduction in minimizing the incidence of avascular necrosis in developmental dysplasia of the hip.

Avascular necrosis of the femoral head is the most serious complication after closed reduction in developmental dysplasia of the hip. Although arthrography has a well-established role in the treatment of developmental dysplasia of the hip, its use is not universal. A prospective study was conducted to compare the incidence of avascular necrosis after closed reduction in developmental dysplasia of the hip performed with and without arthrography in 85 patients, with a minimum of 5 years follow up. Arthrographic criteria were evaluated including lateralization of the femoral head and the type of limbus encountered. Hips treated by closed reduction based on arthrographic evaluation had significantly less incidence of avascular necrosis when compared with those treated by closed reduction without arthrographic guidance. Closed reduction with lateralization of more than 4 mm, and those hips with an inverted limbus were associated with an increased risk of avascular necrosis.

The pattern of developmental dysplasia of the hip.

OBJECTIVE: This study was conducted to enlarge the knowledge of developmental dysplasia of the hip (DDH) in the Kingdom of Saudi Arabia (KSA), and to compare its presentation among Saudi population to known international figures. METHODS: A prospective study of Saudi patients with DDH that presented to King Khalid University Hospital, Riyadh, KSA over 5 years starting September 1996. The information needed was obtained directly from one or both parents. RESULTS: Six hundred Saudi children were included in this study. The diagnosis of DDH was delayed in most patients. The results give an impression that parents' consanguinity, positive family history, breech deliveries and the use of swaddling have direct relation with increased incidence of DDH in the Saudi population. CONCLUSION: A national screening program is needed in KSA. Furthermore, nationwide studies will help to identify groups at risk and the geographical distribution of the disorder.

Fixed forefoot adduction after clubfoot surgery.

OBJECTIVE: Studying the causes of residual forefoot adduction deformity after surgical treatment of congenital clubfoot and their management. METHODS: Revision surgery was carried out by the author for 12 patients (13 feet) in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, during the period between January 1997 to December 1998. RESULTS: In 12 out of 13 feet, K-wire was not used to fix the navicular bone in its reduced position during primary surgery. In all cases, the navicular was found displaced during revision surgery. CONCLUSION: Revision of soft tissue surgery with relocation of the navicular bone improves the outcome of patients with residual fixed forefoot adduction after congenital talipes equinovarus surgery.