Vol 41 # 3 September 2009 - Kma.org.kw

236
KUWAIT MEDICAL JOURNAL September 2009
Original Article
Clinical and Radiological Aspects of Closed
Reduction in Developmental Dysplasia of the Hip
Treated in the First Six Months
Mohamed Z Hatata 1 , Nariman Aboloyoun 2 , Eva M Bilke 2 , Ralf Stuecker 2
1
Department of Orthopedics, Al-Razi Hospital, Kuwait
2
Department of Pediatric Orthopedics, Altona Children Hospital, Hamburg, Germany
Kuwait Medical Journal 2009; 41 (3): 236-239
ABSTRACT
Objective: To evaluate the success rate and subsequent
restoration of normal acetabular angle (AC°), and
associated growth changes secondary to avascular
necrosis of the proximal femur in cases of developmental
dysplasia of the hip (DDH) treated during the first six
months of life
Design: Retrospective study from 1998 to 2006
Setting: Department of Pediatric Orthopedics, Altona
Children Hospital, Hamburg, Germany
Subjects: Twenty six patients with twenty nine dysplastic
hips were evaluated regarding grade of hip dysplasia. The
success rate of closed reduction, postoperative restoration
of normal acetabular coverage (AC angle) and associated
complication were noted.
Intervention: Closed reduction of DDH with intraoperative
arthrogram followed by spica cast
Main Outcome Measures: Success rate of closed reduction
and restoration of normal acetabular index.
Results: Closed reduction could be achieved in twenty two hips
(76%). Out of those twenty two hips fifteen (68%) developed
normal acetabular index, six (27%) showed persistent acetabular
dysplasia and one (5%) had border -line measurement.
Closed reduction was not successful in seven hips.
Those seven hips were treated by open reduction and
capsulorrhaphy.
Conclusion: Closed reduction of DDH in the first six
months of life was achieved in (76%) of dislocated hips,
and did not show any significant growth changes in the
proximal femur.
The early changes in the ossific nucleus of capital femoral
epiphysis (CFE) alone were found to be of very little value
in predicting the nature of development of the hip.
KEY WORDS: closed reduction, developmental dysplasia of the hip
INTRODUCTION
In developmental dysplasia of the hip (DDH)
early reduction is the main goal of treatment to
make use of the greatest potential for acetabular
remodeling. The cartilaginous femoral head in
the early months of life is extremely vulnerable
to avascular necrosis (AVN). Indeed this is the
period during which the results of closed reduction
treatment can and virtually be perfect [1] .
In the presence of ossific nucleus of capital
femoral epiphysis (CFE) hips can be evaluated
radiographically but before ossificationcartilaginous
femoral heads are evaluated using ultrasound. The
Graf method focuses on the evaluation of anatomic
characteristics of the hip [2] . This is accomplished by
measuring the alpha angle, a measure of the slope
of the superior aspect of the acetabulum, and beta
angle, which evaluates the cartilaginous component
of the acetabulum. With the Graf classification
morphological features of the anatomy are converted
into hip types.
The aim of this study was to evaluate the
success rate and subsequent restoration of normal
acetabular angle (AC°), and associated growth
changes secondary to avascular necrosis of the
proximal femur in cases of DDH treated in first six
month of life .
PATIENTS AND METHODS
The records of children with DDH admitted and
treated in the Pediatric Orthopedic department in
Altona Children Hospital, Hamburg, Germany
between June 1998 and January 2007 were
reviewed. Only cases of DDH that satisfied our
criteria were included. Inclusion criteria were cases
treated by closed reduction in the first six months
Address correspondence to:
Mohamed Zaki Hatata,FRCS (Glasgow), PO Box 5102, Hawalli – 32082, Kuwait. Tel: 97194179, E-mail: mzhatata@hotmail.com