Anterolateral-approach Open Reduction Combined with Pemberton Pericapsular Osteotomy and/or Femoral Osteotomy for Hip Dislocation in Children.

Introduction: Among all the traumatic hip dislocations, anterior hip dislocation is a rarity in which the obturator inferior variety is one of the rarest to be documented [1]. Here we present to you the case of our patient, a 35-year-old male with a six month neglected obturator variety of anterior hip dislocation treated by salvage procedure of open reduction without the need for intertrochanteric osteotomy and resultant preserved natural hip for ambulation as an intermediary procedure. Case Report: Mr. SH a 35-year-old male had a fall from 15 feet in his village and was treated by a local quack, Meanwhile the patient continued to experience pain and difficulty walking and after an ordeal of nearly 6 months during the lockdown period in coronavirus disease pandemic, showed up in our emergency room and was diagnosed with an obturator type anterior hip dislocation for which we carried out open reduction aided with Murphys skid through an anterolateral approach and stabilization using two Steinman pins and further immobilization by Thomas splint for a period of 15 days, which was done after confirmation of intact head vascularity under general anesthesia after which gradual mobilization was initiated. 3 months post operative, now patient is ambulatory with stick support with no deformity, no pain and with early radiological features of avascular necrosis (AVN) for which Total Hip Replacement (THR) is planned at a later date. Conclusion: Utilisation of salvage procedures and moreover those with minimal operative complications will result in better, natural long-term intermediary measure outcome with a resultant delay in joint replacement procedure which is in the better interest of the patient. Keywords: Anterior hip dislocation, open reduction, obturator inferior type, neglected dislocation, Anterolateral approach.

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Total Hip Arthroplasty for High Hip Dislocation

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0946-2750 ◽

2020 ◽

Vol 158 (02) ◽

pp. 170-183 ◽

Cited By ~ 1

Author(s):

Sebastian Hardt ◽

Robert Hube ◽

Carsten Perka

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Hip Dislocation ◽

Primary Stability ◽

Postoperative Management ◽

Femoral Osteotomy ◽

Anterolateral Approach ◽

Total Hip ◽

Increased Risk ◽

Centre Of Rotation

Abstract Introduction Total hip arthroplasty in patients with high hip dislocation is a surgically demanding procedure. This is due to the congenital disorder of hip maturation and the resulting anatomical features. The aim of the arthroplasty is implantation of the cup prosthesis in the original centre of rotation, at the same time correcting femoral deformities and reducing the hip joint. Indications The indications include advanced osteoarthritis in the secondary acetabulum, existing instability, severe contractures and secondary changes in adjacent joints. Contraindications The contraindications include cerebrospinal dysfunction with impaired coordination, muscular dystrophies, overt metabolic bone disorders and complete or nearly complete absence of muscles that stabilise the hip/hip-stabilising musculature. Operation Technique The operation is preferably performed through an anterolateral approach with the patient supine or through a posterolateral approach with the patient on his side. Sparing the pelvitrochanteric muscles is crucial for the functional outcome. Exposure of the original acetabulum is essential for correct and secure placement of the cup component. We perform planned shortening femoral osteotomy above an increase in length of more than 3.0 cm in patients without previous surgery and depending on the operative findings in previously operated patients. As a rule of thumb, the bone fragment to be removed should be approximately 60% of the distance between the planned and the preoperative position of the trochanter tip. Additional fixation is necessary only in the absence of primary stability between the parts of the femur divided by the osteotomy. Postoperative Management In these patients, the postoperative management is determined individually depending on the stability of the prosthetic cup fixation, bone quality, rotational stability of the stem in both segments of the femur after the osteotomy, existing soft tissue contractures and the resulting postoperative leg length difference. Complications The most frequent complications are nerve injuries, femoral fractures, malpositioning of the components, absence of integration of the components (usually due to inadequate primary stability), joint instability due to damage to the pelvitrochanteric muscles and therefore an increased risk of dislocation, pseudarthrosis of the femoral osteotomy and increased perioperative blood loss due to the prolonged operation time. Results The currently published results show that subtrochanteric shortening osteotomy in patients with high hip dislocation with anatomic reconstruction of the original centre of rotation delivers good functional results with insignificantly increased 10-year loosening rates compared with standard management of primary hip osteoarthritis.

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Open reduction, Dega osteotomy and proximal femoral osteotomy in delayed diagnosis of developmental hip dislocation: outcome at 40-year follow-up

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.210006 ◽

2021 ◽

pp. 1-7

Author(s):

Łukasz Wozniak ◽

Maciej Idzior ◽

Marek Józwiak

Keyword(s):

Risk Factors ◽

Hip Replacement ◽

Open Reduction ◽

Survival Rates ◽

Hip Dislocation ◽

Femoral Osteotomy ◽

Fertility Rate ◽

Level Of Evidence ◽

Proximal Femoral Osteotomy

Purpose Late-diagnosed dislocated hips underwent open reduction, Dega osteotomy, and proximal femoral osteotomy between 1968 and 1988. The objectives of this study are to assess the survival of hips into adulthood, clinical and radiological outcome, patients’ life perspectives and the risk factors of failure. Methods An assessment of 67 hips treated when younger than five years (<age 5yr. group) and 71 hips in the group aged older than five years (+age 5yr.) was performed. All cases were evaluated clinically and radiographically, and survival was assessed, considering hip replacement as endpoints for failure (abbreviation HR+ refers to hips that underwent hip replacement surgery; HR- refers to hips that have not been replaced at the follow-up). The fertility rate and the social security disability benefits (SSDB) recipiency percentage were calculated. Results The 40-year survival rates were 73% (95% confidence (CI) 71% to 76%) in the <age 5yr. group, 54% (95% CI 51% to 57%) in the +age 5yr. group, 70% (95% CI 67% to 73%) in one-sided dislocations and 57% (95% CI 54% to 60%) in bilateral dislocations. At follow-up, the median Harris hip and Western Ontario and McMaster Universities Osteoarthritis scores were 90.0 and 13.0 (<age 5yr. group, HR-), 74.0 and 28.0 (+age 5yr. group, HR-), 90.0 and 16.0 (<age 5yr. group, HR+) and 84.5 and 11.5 (+age 5yr. group, HR+), respectively. The operation normalized the radiological parameters. The correlation between the grade of femoral head avascular necrosis (AVN) at a median 2.6 years after the operation and the grade of osteoarthritis at follow-up was 0.38 (p < 0.001). The fertility rate was 1.54. In total, 16.0% (aged under five years) and 38.5% (aged over five years) of patients were receiving SSDB (p = 0.003). Conclusion Early failure risk factors are older age at the surgical procedure, high AVN grade and bilateral hip involvement. Still, the results facilitate hip reposition whenever technically manageable, even in teenagers. Level of evidence III

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Hip dislocation following the treatment of femoral neck fracture: Case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1004248v ◽

2010 ◽

Vol 138 (3-4) ◽

pp. 248-251

Author(s):

Zoran Vukasinovic ◽

Igor Seslija ◽

Borislav Dulic

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Open Reduction ◽

Weight Bearing ◽

Young Patients ◽

Hip Dislocation ◽

Full Weight Bearing ◽

Limited Range Of Motion ◽

Femoral Head Osteonecrosis ◽

Neck Fracture

Introduction. Femoral neck fractures are very rare in young patients and are frequently complicated by femoral head osteonecrosis and femoral neck nonunion. Case Outline. A 19-year-old girl with hip dislocation following the treatment of the femoral neck fracture is presented. The femoral neck fracture was initially treated by open reduction and three-screw fixation. After detecting the nonunion of femoral neck, valgus osteotomy was done. Secondary, iatrogenic, hip dislocation appeared. The patient had pains, and in clinical findings a shorter leg and limited range of motion in the hip - altogether 40 degrees. She was then successfully treated by open reduction, together with Chiari pelvic osteotomy and joint transfixation. Transfixation pin was removed three weeks following the operation. After that, the patient was put into the abduction device and physical therapy was started. The mentioned regimen lasted four months after the surgery, then the abduction device was removed and walking started. Full weight bearing was allowed eight months after surgery. Conclusion. As we have not found the literature data concerning the above mentioned problem, we solved it in the way that we usually do for the treatment of developmental dislocation of the hip in adolescence.

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A COMPREHENSIVE PELVIC AND FEMORAL OSTEOTOMY REVISION TO TREAT A FAILED PELVIC AND FEMORAL OSTEOTOMY: A CASE REPORT

Journal of Musculoskeletal Research ◽

10.1142/s0218957721500226 ◽

2021 ◽

pp. 2150022

Author(s):

Panos K. Megremis ◽

Orestis P. Megremis

Keyword(s):

Surgical Procedure ◽

Open Reduction ◽

Pelvic Osteotomy ◽

Femoral Osteotomy ◽

Salter Osteotomy ◽

Shortening Osteotomy ◽

Innominate Osteotomy ◽

Walking Age ◽

One Year

Hip’s open reduction combined with Salter innominate osteotomy and femoral osteotomy is the treatment of choice when treating Developmental Dislocation of the Hip (DDH) at walking age. We report a case of a five-year-old girl who underwent a failed surgical procedure of hip’s open reduction, Salter innominate osteotomy, and the femoral osteotomy. One year later, one-stage surgical procedure of hip’s open reduction, Dega pelvic osteotomy, and femoral de-rotation varus shortening osteotomy was performed. During the five-year follow-up, the clinical outcome was evaluated as excellent. The Dega pelvic osteotomy is an effective pelvic osteotomy for DDH, in a case of a failed Salter osteotomy.

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Surgical Technique: Open Hip Dislocation, Open Reduction, and Internal Fixation

10.1007/978-1-4614-7321-3_87-2 ◽

2021 ◽

pp. 1-8

Author(s):

Mara L. Schenker ◽

Max E. Davis ◽

Samir Mehta ◽

Jaimo Ahn

Keyword(s):

Surgical Technique ◽

Internal Fixation ◽

Open Reduction ◽

Hip Dislocation

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External fixation-assisted reduction for the treatment of neglected hip dislocations with limb length discrepancy: a retrospective study of 13 cases

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-3015-0 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Pengyu Li ◽

Fulin Tao ◽

Wenhao Song ◽

Jinlei Dong ◽

Daodi Qiu ◽

...

Keyword(s):

External Fixation ◽

Open Reduction ◽

Hip Dislocation ◽

Limb Length Discrepancy ◽

Limb Length ◽

Acetabular Fractures ◽

External Fixators ◽

Residual Limb ◽

Second Stage ◽

Length Discrepancy

Abstract Background The purpose of this study was to evaluate a new method for treating neglected hip dislocation with limb length discrepancy by using external fixation-assisted pre-reduction. Methods Thirteen patients admitted between January 2010 to February 2018 with a mean duration from injury to surgery of 5.0 ± 2.1 months and an average preoperative leg-length discrepancy of 7.7 ± 2.3 cm were enrolled in this study. The dislocation and associated acetabular fracture type, clinical outcomes and residual limb length discrepancy were evaluated. Results All patients had posterior dislocations, and nine patients presented with acetabular fractures and were followed-up for at least 12 months. The average traction duration of external fixators was 28.8 ± 8.0 days and all patients received second-stage open reduction and internal fixation. Six patients showed residual limb length discrepancy within 2 cm. Patients showed significant improvement in hip function and pain relief. Complications including avascular femoral head necrosis and osteoarthritis occurred in three patients. Conclusion Effective correction of limb length discrepancy and improved function were observed in patients with neglected hip dislocations and limb equality using traction by external fixation combined with second-stage open reduction. Further follow-up is required to determine long-term outcomes.

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