THE SIBLINGS’ PROBLEMS: REPORT OF TWO NEGLECTED DDH
NAA N.Alyani1, AR Ardilla Hanim1, A M.Shukrimi1
1 Department of Orthopaedic, Traumatology and Rehabilitation, Kulliyyah of Medcine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
INTRODUCTION: The surgical management of neglected developmental dysplasia of the hip (DDH) in walking children has always been a challenge to orthopaedic surgeons. Multiple studies reported on different types of approaches and acetabuloplasty methods.
METHODS: Here, we report 2 cases of sisters aged 9 and 10 years old who presented with unilateral painless limp since childhood. Clinically, they walked with short limb gait with shortening of 5 and 6 cm each. The younger sister has right neglected DDH (Fig 1) while the elder has left sided (Fig 2).
They underwent open reduction, capsulorraphy, varus derotation osteotomy of proximal femur and shelf acetabuloplasty. Hip ilioinguinal approach were used with separate lateral approach to proximal femur. We were able to get concentric reduction of the hip and stable after the acetabuloplasty and femoral shortening about 2 to 2.5cm. The graft used was from femoral osteotomy and held with 2 K-wires and another K-wire for maintaining the concentric reduction. Femoral osteotomy was fixed with small dynamic compression plate with 4 screws. They were immobilised with hip spica for initial 6 weeks where removal of wire and change of spica were done; then continued to another 6 weeks before it was removed and partial weight bearing was allowed.
RESULTS: They developed early complication of pressure sore and superficial SSI at 3-6weeks post operatively that resolved with dressing. At latest review about 10 months post operatively, patient were active but with some abductors weakness which has been improving the previous review. The reduction is maintain and shelf bone graft were well incorporated (Figure 3).
DISCUSSION & CONCLUSIONS: A stable painless mobile hip is the aim of the management1,2. Regardless of any surgical methods and surgical approaches, excellent to good McKay criteria reported up to 85-100%2,3,4 of cases. Similar principles are applied in DDH surgical reconstruction at any age, but in patients aged more than 8 year-old, acetabular development should not be expected hence effort should be made to reconstruct. No evidence in the literature to support the deterioration of hips due to any osteoarthritic changes up to 6 years of follow up. If this is happen in the future, hip replacement will be made much easier1.
REFERENCES: 1 M.El-Sayed et al, (2012), The effect of Dega acetabuloplasty and Salter innominate osteotomy on acetabular remodeling monitored by the acetabular index in walking DDH patients between 2 and 6 years of age: short- to middle-term follow-up, J Child Orthop 6:471–47. 2 HE El-Tayeby, (2009) One-stage hip reconstruction in late neglected developmental dysplasia of the hip presenting in children above 8 years of age, J Child Orthop 3:11–20. 3 I Qadir et. al. (2018) One-stage Hip Reconstruction for Developmental Hip Dysplasia in Children over 8 Years of Age, Korean Medical Journal. 4 Vallamshetla VRP et al. (2006), Congenital dislocation of the hip a re-appraisal of the upper age limit for treatment, J Bone Joint Surg Br. Aug;88(8):1076-8
