Simultaneous open reduction and salter innominate osteotomy for developmental dysplasia of the hip

Abstract

Objective: To highlight the presence of this uncommon developmental disorder in our set up and show that simultaneous open reduction and salter innominate osteotomy can restore normal hip development Design: Prospective study. Setting: Kenyatta National Hospital between 2002 and 2004. Subjects: Children with typical developmental dysplasia of the hip (DDH) who were 18 months and above were operated on. Methods: Clinical and radiological assessment of the hips was done and skin traction was applied for between two to four weeks until femoral head came down to the level of the acetabulum. Open reduction, iliopsoas and adductor releases, capsulorraphy and salter innominate osteotomy was then done. The graft was held by two smooth Kirschner (k) wires. Unlike Salter, the femoral head was held in the socket by a smooth Kwire. A hip spica was applied for 12 weeks and thereafter the children were allowed to mobilize freely at their own pace. Follow up clinical and radiological assessment was done. Results: Two female children with three congenital dislocations of the hips were operated. They were 18 months and three and a half years old at the time of the initial surgery. At follow up of between nine and 27 months, there was good initial clinical and radiological outcome. The average acetabular index dropped from an average of 41 degrees pre-operatively to an average of 18 degrees post-operatively. Conclusion: This operation redirects the acetabulum without deepening it, achieving good femoral head coverage. Long term follow is intended. Pooling of patients with this uncommon disorder in our environment is advocated to further develop surgical competency. Early competent screening of new born babies could enable early conservative management with good outcome.