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Radiographic outcome of children older than twenty-four months with developmental dysplasia of the hip treated by closed reduction and spica cast immobilization in human position: a review of fifty-one hips

  • YiQiang Li
  • YueMing Guo
  • XianTao Shen
  • Hang Liu
  • HaiBo Mei
  • HongWen Xu
  • Federico CanaveseEmail author
  • Chinese Multi-center Pediatric Orthopedic Study Group (CMPOS)
Original Paper
  • 37 Downloads

Abstract

Purpose

This study aimed to investigate the radiographic outcomes, rate of redislocation, and avascular necrosis of proximal femoral epiphysis (AVN) in patients aged 24 to 36 months with developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization in human position.

Material and methods

We reviewed the medical records of 39 patients (51 hips) aged 24 to 36 months with DDH treated by CR and spica cast immobilization in human position. The Tönnis grade, rate of redislocation and AVN, acetabular index (AI), centre-edge angle (CEA), and Severin radiographic grade were evaluated on plain radiographs.

Results

Among the included 39 patients (51 hips), 15 hips (29.4%) were Tönnis grade II, 24 hips (47.1%) were grade III, and 12 hips (23.5%) were grade IV. In 47 hips (92.2%), the ossific nucleus was present at the time of CR. Stable reduction was achieved by CR in 39/51 hips (76.5%) and redislocation occurred in 12/51 hips (23.5%). Among the 12 hips that redislocated, 11 underwent open reduction and one repeated CR. Two out of 40 hips (5%) treated by CR developed AVN. Overall, 54.6% of the hips had satisfactory outcomes (39.2% Severin type I and 17.6% type II), while 45.4% had unsatisfactory outcomes (39.2% Severin type III and 3.9% type IV). Of the 40 hips treated by CR, 57.5% and 42.5% of cases had satisfactory outcomes and residual acetabular dysplasia, respectively. Six out of 11 hips (54.6%) treated by open reduction and pelvic osteotomy had satisfactory outcomes.

Conclusions

Our study showed that stable CR could be achieved in 76.5% of patients aged 24 to 36 months with DDH at the time of index procedure. Satisfactory outcomes can be expected in 56.4% of the cases (5.0% AVN rate), although late acetabular dysplasia may develop in 43.6% of the hips.

Keywords

Developmental dysplasia of the hip Closed reduction Redislocation Avascular necrosis Proximal femoral epiphysis Age 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures were performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

No patients were involved. This is a retrospective study of patients’ data, and an IRB approval was obtained (GZWCMC 2015020904).

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Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  1. 1.GuangZhou Women and Children’s Medical CenterGuangZhou Medical UniversityGuangZhouChina
  2. 2.Foshan Hospital of TCMFoshanChina
  3. 3.Wuhan Women and Children Medical Care CenterWuhanChina
  4. 4.Children’s Hospital of Chongqing Medical UniversityChongqingChina
  5. 5.Hunan Children’s HospitalChangShaChina
  6. 6.Department of Pediatric OrthopaedicsGuangZhou Women and Children’s Medical CenterGuangZhouChina

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