Outcome of one stage combined open reduction, pelvic and derotation femoral osteotomy in congenital dislocated hips of children younger than three years age

Objective: to determine the outcome of one-stage combined operative management of congenital dislocation of hips in children aged 18-36 months. methods: the descriptive case series study was conducted at the department of orthopaedic surgery, jinnah postgraduate medical centre, karachi, from january 2005 to december 2011. children aged 18-36 months suffering from congenital dislocation of hips were included. those with tonnis stage iii and iv were managed with one-stage operative procedure without preliminary traction. the operative procedure included adductor tenotomy, open reduction, capsulorraphy, salter's osteotomy and a femoral derotation osteotomy. catteral's 'test of stability' was used after open reduction as an indicator for need of pelvic and femoral osteotomies. follow-up ranged between 1 and 7 years. the patients were evaluated clinically on mckay's criteria and radiologically on severin's criteria. klisic's overall rating was used to know mean of the assessments. results: there were 38 patients with 50 congenital dislocations of hip. there were 26(68.42%) females and 12(31.57%) males with a female-to-male ratio of 2:1. mean age at the time of operation was 24.26±7.6 months. of the total, 12(31.57%) patients had bilateral involvement, 11(28.94%) had right-sided and 15(39.47%) had left- sided involvement. right side to left ratio was 1:1.2. at the time of last follow-up, 25(50%) hips behaved excellent on mckay's criteria. according to radiographic classification on severin's criteria, 24(48%) hips were in excellent class. avascular necrosis of femoral head was noted in 3(6%) hips, re-subluxation/re-dislocations were observed in 3(6%) hips and 1(2.6%) patient had 1cm femoral lengthening. conclusion: one-stage open reduction, capsulorrapyhy, salter's osteotomy and femoral derotation osteotomy without preliminary traction to re-locate congenital dislocation of hips in late presenting children is a safe and highly effective method. it produces a low rate of complication and need for repeat surgery. it reduces the cost of treatment, minimises socio-economic burden and psychological trauma incurred by lengthy hospitalisation of treatment with traction followed by closed reduction.