Artikel
Open reduction of irreducible hip dislocation in infants with DDH
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Autoren
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Jan Matussek
- Orthopädische Klinik Universität Regensburg, Kinderorthopädie, Regensburg-Bad Abbach, Germany
| Veröffentlicht: | 6. November 2018 |
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Gliederung
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Objectives: The aim of this retrospective study is to demonstrate the characteristics of traditional and more modern methods of retaining the femoral head in the acetabular socket after successful reduction of the infant hip joint in severe DDH.
Methods: Retention techniques with Kirschner wires for 6 weeks in a cohort of 28 cases of infant hip dislocation between 1993 and 2004 were compared with the outcome of a second cohort of 31 cases of open hip reduction using the Ligamentum-capitis-femoris-to-capsule plasty between 2004 and 2016.
Patients characteristics: Age range of the infants: 9 weeks to 8 months. Gender: 40 girls and 11 boys; 7 infants with systemic skeletal problems; 8 infants with bilateral hip dislocation, 43 unilateral dislocations. All children had diagnostic and screening hip ultrasound and inconsistently underwent previous traditional conservative treatment including orthotics, manipulation under GA, hip spica, short-term overhead extension. Surgery was only considered after careful evaluation of all options.
Results: The retention of 28 femoral heads with K-wires and a hip spica for 6 weeks resulted in 9 minor and 4 major complications: Those considered minor were 7 subcutaneous infections and 2 external premature dislocations of the wire with loss of retention. Major complications were 3 migrations of the K-wire tip into the pelvis of up to 3 cm and 1 loss of retention with wire in-situ.
In this cohort 2 infants suffered secondary redislocation. In the ligamentum-plasty cohort, all femoral heads could be retained concentrically in 6 weeks of spica treatment and only 2 infants lost concentric retention within a post-spica period of 12 months and subsequently needed further interventions. In each cohort 2 infants had a temporary growth disturbance of the ossification center. In the second cohort 1 child contracted Perthes disease at 4 years of age.
Conclusions: Ligamentoplasty seems to incur fewer major complications in the primary concentric retention of the reduced hip joint in infants. However, both methods could not prevent an equal number of secondary loss of concentric positioning of the femoral head.
