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. 2023 Nov;57(6):329-333.
doi: 10.5152/j.aott.2023.22151.

Closed versus medial open reduction in the treatment of developmental dysplasia of the hip under age 1: A retrospective comparative study

Sancar Bakircioğlu  1 , Riza Mert Cetik  2 , Murat Danisman  3 , Mehmet Askin  4 , Muhammed Abdulkadir Bulut  4 , Guney Yilmaz  4
Affiliations

Closed versus medial open reduction in the treatment of developmental dysplasia of the hip under age 1: A retrospective comparative study

Sancar Bakircioğlu et al. Acta Orthop Traumatol Turc. 2023 Nov.

Abstract

Objective: This study aimed to compare the mid-term results of closed reduction (CR) versus medial open reduction (MOR) in the treatment of children with developmental dysplasia of the hip (DDH) under age 1.

Methods: Thirty-four patients with DDH (41 hips) were included in this retrospective study with a mean follow-up of 4.2 years (range: 2-6.9 years). All hips were then divided into 2 groups based on the treatment type: the CR group (20 hips) and the MOR group (21 hips). All hips from both groups were assessed with post-spica magnetic resonance imaging (MRI) in the first 24 hours, and reinterventions were recorded. Medial dye pool width was also measured.

Results: Age at the time of reduction was similar between the CR and MOR groups (6.6 ± 1.3 months vs. 6.7 ± 1.6 months). There was no significant difference between groups regarding avascular necrosis rate and further corrective surgery (FCS) requirement (P=.454, .697). The appropriate reduction was seen at 38/41 hips. Three hips in the CR group had revealed dislocation in post-spica MRIs and required re-intervention, and none of the hips in the MOR group required re-intervention (P=.107). Medial dye pool width in 3 planes showed no significant difference between MOR and CR.

Conclusion: There is no difference in the avascular necrosis rate and FCS requirements between CR and MOR under age 1. Post-spica MRI is a favorable tool for evaluating reduction after CR, but its efficacy after MOR is questionable.

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Conflict of interest statement

Declaration of interests: The authors have no conflict of interest to declare.

Figures

Figure 1.
Figure 1.
Three-plane (30° anterior, neutral, and 30° posterior) measurement of medial dye pool (MDP) on mid-axial magnetic resonance imaging (MRI) in post-spica MRI. The MDP is calculated by dividing the A, B, and C distances in the femoral head width.
Figure 2.
Figure 2.
Radiographic example for both closed (A, B) and medial open (C, D) reduction. Both patients underwent initial surgery at 6 months. Favorable radiologic outcomes were obtained during the 4-year follow-up.
Figure 3.
Figure 3.
Immediate post-spica magnetic resonance image after closed reduction revealed a subluxated left hip. Patient treated with subsequent anterior open reduction.
See this image and copyright information in PMC

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