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The surgical treatment of established congenital dislocation of the hip: results of surgery after planned delayed intervention following the appearance of the capital femoral ossific nucleus

The surgical treatment of established congenital dislocation of the hip: results of surgery after planned delayed intervention following the appearance of the capital femoral ossific nucleus
The surgical treatment of established congenital dislocation of the hip: results of surgery after planned delayed intervention following the appearance of the capital femoral ossific nucleus
It has been proposed that the presence of the capital femoral ossific nucleus confers protection against ischemic injury or avascular necrosis (AVN) at the time of reduction of a congenitally dislocated hip. The current literature is contradictory. A prospective study was undertaken of the clinical and radiologic outcomes following closed or open reduction. Fifty hips were included in the study. These cases had presented late or had failed conservative treatment. In 28 hips treatment was intentionally delayed until the appearance of the ossific nucleus (but not beyond 13 months) and in 22 the ossific nucleus was present at clinical presentation. Six hips reached the age of 13 months without an ossific nucleus appearing and progressed to treatment. The significant AVN rate (more than grade 1) was 7% for closed reduction and 14% for open. However, the amended rate if hips were excluded that had failed Pavlik harness treatment was 0.0% and 9%, respectively (4% overall). Further surgical procedures were necessary in 57% of hips undergoing closed reduction and 41% after open, which compares favorably with other series. The authors conclude that the presence of the ossific nucleus is an important factor in the prevention of AVN, particularly after late closed reduction. Intentional delay in the timing of surgery does not condemn a hip to open surgery, but there is a comparable rate of secondary procedures becoming necessary, particularly after closed reduction. A simultaneous pelvic procedure may be appropriate after late closed reduction. The delayed strategy to await the appearance of the ossific nucleus for previously untreated dislocation allows a simple treatment algorithm to be employed that produces good clinical and radiologic outcomes.
0271-6798
434-439
Clarke, Nicholas M.
76688c21-d51e-48fa-a84d-deec66baf8ac
Jowett, Andrew J.
6731ff6e-92be-4fa6-957d-2936f36b23bd
Parker, Lee
9d634e1c-5493-4a48-86ac-37c44c89f394
Clarke, Nicholas M.
76688c21-d51e-48fa-a84d-deec66baf8ac
Jowett, Andrew J.
6731ff6e-92be-4fa6-957d-2936f36b23bd
Parker, Lee
9d634e1c-5493-4a48-86ac-37c44c89f394

Clarke, Nicholas M., Jowett, Andrew J. and Parker, Lee (2005) The surgical treatment of established congenital dislocation of the hip: results of surgery after planned delayed intervention following the appearance of the capital femoral ossific nucleus. Journal of Pediatric Orthopaedics, 25 (4), 434-439.

Record type: Article

Abstract

It has been proposed that the presence of the capital femoral ossific nucleus confers protection against ischemic injury or avascular necrosis (AVN) at the time of reduction of a congenitally dislocated hip. The current literature is contradictory. A prospective study was undertaken of the clinical and radiologic outcomes following closed or open reduction. Fifty hips were included in the study. These cases had presented late or had failed conservative treatment. In 28 hips treatment was intentionally delayed until the appearance of the ossific nucleus (but not beyond 13 months) and in 22 the ossific nucleus was present at clinical presentation. Six hips reached the age of 13 months without an ossific nucleus appearing and progressed to treatment. The significant AVN rate (more than grade 1) was 7% for closed reduction and 14% for open. However, the amended rate if hips were excluded that had failed Pavlik harness treatment was 0.0% and 9%, respectively (4% overall). Further surgical procedures were necessary in 57% of hips undergoing closed reduction and 41% after open, which compares favorably with other series. The authors conclude that the presence of the ossific nucleus is an important factor in the prevention of AVN, particularly after late closed reduction. Intentional delay in the timing of surgery does not condemn a hip to open surgery, but there is a comparable rate of secondary procedures becoming necessary, particularly after closed reduction. A simultaneous pelvic procedure may be appropriate after late closed reduction. The delayed strategy to await the appearance of the ossific nucleus for previously untreated dislocation allows a simple treatment algorithm to be employed that produces good clinical and radiologic outcomes.

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Published date: 2005

Identifiers

Local EPrints ID: 25369
URI: http://eprints.soton.ac.uk/id/eprint/25369
ISSN: 0271-6798
PURE UUID: 39166098-5703-4fcc-adb5-0d9f11ea0d97

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Date deposited: 10 Apr 2006
Last modified: 15 Jul 2019 19:16

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