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Scientific Articles   |    
A Combined Procedure for High Dislocation in Patients with Developmental Dysplasia of the Hip
Ting-Ming Wang, MD, PhD1; Kuan-Wen Wu, MD1; Shier-Chieg Huang, MD, PhD1; Wei-Cheng Huang, MD1; Ken N. Kuo, MD2
1 Department of Orthopaedic Surgery, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan
2 School of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan. E-mail address: kennank@aol.com
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Based on an original article: J Bone Joint Surg Am. 2013 Jun 19;95(12):1081-6.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2013 Oct 09;3(4):e19 1-16. doi: 10.2106/JBJS.ST.M.00037
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Extract

Overview
Introduction

A combined procedure including open reduction, femoral shortening osteotomy, and an acetabular procedure is often necessary to obtain a desirable result in children of walking age who have a high-riding hip dislocation.

Step 1: Surgical Approach

A careful approach to the femoral head and acetabulum is required to avoid injury to nerves, vessels, and cartilage.

Step 2: Explore the Hip Joint

Make sure to find the true acetabulum and remove all obstacles to femoral head reduction.

Step 3: Femoral Head Reducibility

Check the reducibility of the femoral head in different positions through a full range of hip motion.

Step 4: First Femoral Osteotomy

Expose the proximal part of the femur subperiosteally and make necessary markers for determining the amount of shortening and rotation at the time of osteotomy.

Step 5: Hip Joint Stability

Check femoral head reduction stability with the proximal end of the osteotomized femur.

Step 6: Femoral Shortening

Decide the amount of shortening and rotation for the best femoral head reduction.

Step 7: Pemberton Acetabuloplasty

In cases with a dysplastic acetabulum and inadequate femoral head coverage after reduction, perform a Pemberton osteotomy.

Step 8: Postoperative Management

Apply a hip spica cast, which the patient wears for six weeks; then switch to a hip abduction brace.

Results

The patient shown in Figures 26 through 29 and Video 5 was a three-year and six-month-old girl with bilateral developmental dysplasia of the hip that was discovered late (Figs. 26 and 27).

Indications

Contraindications

Pitfalls & Challenges

Figures in this Article

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    Video 1 The femoral head is not reducible.

    Running Time: 0:23

    Video 2 After femoral osteotomy, the femoral head is reducible in internal rotation.

    Running Time: 0:07

    Video 3 The femoral head becomes unstable with external rotation.

    Running Time: 0:21

    Video 4 After Pemberton osteotomy, the femoral head is stable with rotation.

    Running Time: 0:20

    Video 5 Three-dimensional CT scan in 360° of rotation showing high posterior bilateral hip dislocation in the patient shown in Figures 26 through 29.

    Running Time: 0:07

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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