title: Closed reduction with or without adductor tenotomy for developmental dysplasia of the hip presenting at walking age.
abstract: BACKGROUND
  Many children with developmental dislocation of the hip especially in underdeveloped countries reach walking age and still remain undiagnosed, which can be detrimental to their growth and development. Because of the lack medical services often encountered in these regions, it would be attractive to find a cheap and effective treatment. Our work evaluated the results of treatment of these children by closed reduction with or without adductor tenotomy in a prospective study.
  
  
  METHODS
  We included 20 patients in this study with 29 affected hips (15 right and 14 left). Nine patients (45%) had bilateral DDH and 11 (55%) had unilateral DDH. There were 18 girls (90%) and two boys (10%) who were followed up for a mean of 21 mo (18-24 mo). Ages ranged from 9 to 36 mo (mean age 18.3 mo). Patients were divided according to age into two groups: between 9-18 mo and from 19-36 mo. The first group included nine patients (14 hips) while the second had 11 patients (15 hips).
  
  
  RESULTS
  In the first group, closed reduction failed in two patients (two hips) during the follow-up period (14.3%) and this necessitated shift to open reduction, while in the second group only one patient (bilateral DDH) had a similar failure (13.3%). We identified four hips with avascular necrosis. Three of them required no further treatment, the remaining hip was openly reduced.
  
  
  CONCLUSIONS
  Closed reduction in older children offers a valid and reproducible treatment modality in the hands of an experienced pediatric orthopaedic surgeon as long as there is close follow-up and thorough knowledge of possible complications and their management including the ability to shift timely to open reduction.
authors.affiliation: Orthopedics and Traumatology Department, Cairo University, Egypt.
authors.forename: Ahmed Samir
authors.initials: AS
authors.lastname: Barakat
authors.affiliation: Orthopedics and Traumatology Department, Cairo University, Egypt.
authors.forename: Abou Bakr
authors.initials: AB
authors.lastname: Zein
authors.affiliation: Orthopedics and Traumatology Department, Cairo University, Egypt.
authors.forename: Amr Said
authors.initials: AS
authors.lastname: Arafa
authors.affiliation: Orthopedics and Traumatology Department, Cairo University, Egypt.
authors.forename: Mostafa Abdelmaboud
authors.initials: MA
authors.lastname: Azab
authors.affiliation: Orthopedics and Traumatology Department, Cairo University, Egypt.
authors.forename: Walid
authors.initials: W
authors.lastname: Reda
authors.affiliation: Orthopedics and Traumatology Department, Cairo University, Egypt.
authors.forename: Mohamed Mahmoud
authors.initials: MM
authors.lastname: Hegazy
authors.affiliation: Orthopedics and Traumatology Department, Cairo University, Egypt.
authors.forename: Hassan Magdy
authors.initials: HM
authors.lastname: Al Barbary
authors.affiliation: Orthopedics and Traumatology Department, Cairo University, Egypt.
authors.forename: Mohamed Abdelhalim
authors.initials: MA
authors.lastname: Kaddah
keywords: DDH; abductor brace; closed reduction; conservative treatment; delayed diagnosis; walking age