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).
Pitfalls & Challenges
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. Since Klisić and Jancović1,2 first introduced the procedure, femoral shortening has been performed as an adjunct in the …
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