title: 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.
abstract: 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.
  
  
  METHODS
  Level II retrospective study.
authors.affiliation: Department of Orthopaedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Abdul Monem Mohamed
authors.initials: AM
authors.lastname: Alsiddiky
authors.forename: Khalid Abdulla
authors.initials: KA
authors.lastname: Bakarman
authors.forename: Kholoud Omar
authors.initials: KO
authors.lastname: Alzain
authors.forename: Fawzi Fahad
authors.initials: FF
authors.lastname: Aljassir
authors.forename: Abdulaziz Suliman
authors.initials: AS
authors.lastname: Al-Ahaideb
authors.forename: Mamoun Khalid
authors.initials: MK
authors.lastname: Kremli
authors.forename: Mohammed Medhat
authors.initials: MM
authors.lastname: Zamzam
authors.forename: Robert
authors.initials: R
authors.lastname: Mervyn Letts
mesh_terms: D001864:Bone Wires; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007593:Joint Instability / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome