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IN DDH
PRESENTED BY : DR VIVEK VIJAYAKUMAR
CO-MODERATOR : DR MUTHUKUMARAN
MODERATOR : PROF SHAH ALAM KHAN
TERMINOLOGY
Klisic PJ. Congenital dislocation of the hip--a misleading term: brief report. The Journal of bone and
joint surgery. British volume. 1989 Jan;71(1):136-.
OVERVIEW OF MANAGEMENT OF DDH
OPEN REDUCTION
+/-
OPEN REDUCTION
CLOSED REDUCTION ACETABULAR
+/-
OR PROCEDURE
ACETABULAR
OPEN REDUCTION +/-
PROCEDURE
FEMORAL
PROCEDURE
WHY IS OSTEOTOMY REQUIRED IN ADDITION TO
OPEN REDUCTION ?
Unstable reduction
RE-ORIENT THE
FEMORAL HEAD
*Post-reduction avascular necrosis in congenital dislocation of the hip. Cooperman et al :JBJS (Am) 01 Mar 1980, 62(2):247-258
HOW MUCH SHORTENING ?
FEMORAL
OSTEOTOMY
REQUIRED
WHAT TO DO?
PELVIC SIDE
OSTEOTOMY
BOTH SIDE
OSTEOTOMY
INTERTROCHANTERIC VARUS OSTEOTOMY
FEMORAL SHORTENING + DEROTATION OSTEOTOMY
INTERVENTIONS TO ALTER THE MECHANICAL EFFECTS OF AVN
TROCHANTERIC EPIPHYSIODESIS
ACETABULAR
REDIRECTIONAL
OSTEOTOMIES
ACETABULAR VOLUME
REDUCING OSTEOTOMIES
SALVAGE OSTEOTMIES
TYPES OF PELVIC OSTEOTOMIES
Salter RB. Innominate osteotomy in the treatment of congenital dislocation and subluxation of the hip.
J Bone Joint Surg Br. 1961;43(3):518–539.
SALTER’S INNOMINATE OSTEOTOMY
ADVANTAGES:
No effect on acetabular capacity
Technically less demanding
DISADVANTAGES:
Increases Limb length
Femoral Nerve stretch
KALAMCHI’S MODIFICATION OF SALTER’S OSTEOTOMY
Posterior triangular notch is
created in the proximal side of
the osteotomy to engage the
distal iliac segment
Increases stability and prevents
the medial and posterior
displacement.
Limb length discrepancy is
eliminated.
Pemberton PA. Pericapsular osteotomy of the ilium for treatment of congenital subluxation and
dislocation of the hip. JBJS. 1965 Jan 1;47(1):65-86.
PEMBERTON OSTEOTOMY
PEMBERTON OSTEOTOMY
ADVANTAGES:
Osteotomy is incomplete, more stable
Internal fixation is not required
Greater degree of correction can be
achieved with less rotation of the acetabulum.
DISADVANTAGES:
Osteotomy limited by mobility of
Triradiate cartilage
May cause early fusion of triradiate cartilage
PEMBERTON VS SALTER
Steel HH. Triple osteotomy of the innominate bone. A procedure to accomplish coverage of the dislocated or subluxated
femoral head in the older patient. Clinical orthopaedics and related research. 1977(122):116-27.
STEEL OSTEOTOMY (TRIPLE INNOMINATE OSTEOTOMY)
TONNIS OSTEOTOMY
Tönnis D, Behrens K, Tscharani F. A modified technique of the triple pelvic osteotomy: early results.
Journal of pediatric orthopedics. 1981;1(3):241-9.
GANZ (BERNESE) OSTEOTOMY Age: >8-12 yrs
Advantage: better redirection & stability
Osteotomy cuts:
partial (incomplete) osteotomy of the ischium
complete osteotomy of the pubis
biplanar roof shaped osteotomy of the ilium
Does not change the diameter of the true pelvis -birth canal not
affected-advantage in young women
Contraindicated if the triradiate cartilage is still open (interferes with
acetabulum growth).
GANZ (BERNESE) OSTEOTOMY
SPHERICAL ACETABULAR OSTEOTOMIES
E. Dega osteotomy
THANK YOU !