Castañeda LP, Nualart HL, Pérez SMD, Cassis ZN

Language: Spanish
References: 43
Page: 40-46
PDF size: 259.23 Kb.

ABSTRACT

Background: Redislocation after a reduction for developmental dislocation of the hip relatively common. The purpose of this article is to present the current strategies for reducing the rate of redislocation after a reduction. Methods: 645 hips were reviewed which had undergone an open reduction of the hip, at a mean age of 2.1 years, 554 hips underwent a concomitant pelvic osteotomy. In 621 cases a smooth k-wire was placed through the neck and across the joint; we evaluated the position of the pin on the postoperative AP radiograph considering which third of the femoral neck was traversed. We determined the rate of re-dislocation, of avascular necrosis and of superficial and deep infections. Outcome was determined at a minimum of six years using the Severin classification. Results: Re-dislocation occurred in 27 cases (4.1%), 24 had a TAP (3.8%) and 3 did not (12.5%). Avascular necrosis was observed in 127 cases (19.7%). When the pin was in the inferior third of the neck the rate of AVN was 15.2%, compared to when it was in the middle third or superior thirds where it was 23.2%. There was a superficial infection at the pin tract in 96 cases of a TAP and no joint infections. According to the Severin classification 79.8% of the hips with a TAP ended as a type I or II. Conclusion: The use of a TAP was effective in maintaining reduction and was not associated with significant morbidity. Placing the pin in the inferior third of the neck was associated with the lowest rate of avascular necrosis.

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