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Open Reduction in Missed Irreducible Congenital Dislocation of the Hip

March 01, 2013

Contributors: Mohammadreza Chehrassan, MD; Francesco Traina, MD, PhD; Francesco Acri, MD; Camilla Pungetti, MD; Daniele Fabbri, MD; Marcello De Fine, MD; Alberto Corrado Di Martino, MD, PhD; Alice Bondi, MD; Cesare Faldini, MD; Cesare Faldini, MD

Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.
Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.

Treating congenital dislocation of the hip (CDH) is a challenge in a child of walking age. Weightbearing on the dislocated hip elongates the joint capsule and ligamentum teres making the reduction difficult. This video shows the open reduction of a missed irreducible dislocated hip through the anterior approach in a 5-year-old patient affected by developmental dysplasia of the hip. The surgical reduction technique includes an anterior approach through the interval between the sartorius and tensor fascia lata. All retracted elements are identified and released, and any obstacle in the capsule joint is removed. The head of the femur is exposed and gently repositioned in the acetabulum. The reduction is temporarily fixed with a Kirschner wire. Postoperative care includes spica cast for 8 weeks. The authors reviewed 15 hips affected by missed irreducible CDH treated by open reduction through anterior approach at an average of 4 years follow-up (range 4-8 y). In all cases, we were able to relocate the hip with this simple and reproducible open reduction technique that can be associated, if need be, with pelvic or femoral osteotomies. The results showed a low rate of avascular necrosis.

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