Open reduction of congenital hip dislocation by medial approach: case series.
OBJECTIVE
To present the results of medial approach in open reduction of congenital hip dislocation, with the preservation of the medial femoral circumflex artery.


METHODS
We operated on 48 nonreducible hip dislocations diagnosed in children aged 6-27 months. Twenty-two hips (17 patients) were available for clinical and radiographic follow-up. The median age of children at the time of operation was 15 months (range 7-29), and median duration of the follow-up was 4.5 years (range 3-14). The latest radiographic evaluation of the treatment outcome was based on Severins classification.


RESULTS
There were three hips with the loss of concentric reduction. Osteochondritis developed in three, and coxa magna in seven hips. On final evaluation, 19 hips were rated as excellent or good (Severin I or II), and three hips as poor (Severin III or IV): one hip with evident ostechondritis lesions, and two hips with the loss of concentric reduction due to treatment discontinuation.


CONCLUSIONS
By preserving circumflex medial artery and eliminating obstacles to reduction, vascularization of the femur head is ensured. The loss of concentric reduction is prevented by complete removal of all obstacles on the way of the femur head down to the bottom of acetabulum, by postoperative cast immobilization, and by walking with abduction orthosis for an appropriate period of time. Medial approach in surgical management of congenital hip dislocation in infants under 24 months of age is considered safe and efficient procedure.
Trolić
Zdravko
Z
Department of Orthopedics, Mostar University Hospital, Bijeli brijeg bb, 88000 Mostar, Bosnia and Herzegovina. zdravko.trolic@tel.net.ba
Ljubić
Bozo
B
Gavrankapetanović
Ismet
I
Prlić
Jerko
J
Moro
Goran
G
Latincić
Alen
A
D001858:Bone Nails; D017522:Bosnia and Herzegovina; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome