EVALUATION OF MEDIAL APPROACH (LUDLLOF) FOR OPEN REDUCTION OF DEVELOPMENTAL DYSPLASIA OF THE HIP IN CHILDREN
Basrah Journal of Surgery,
Volume 20, Issue 2, Pages 61-68
AbstractDevelopmental dysplasia of the hip is a challenging surgical problem, there are many controversies regarding its management. Open reduction via medial approach is one of its treatment options, which needs further work to evaluate its role in management of Developmental dysplasia of hip. In this study, we tried to put an answer whether the medial incision of open reduction of developmental dysplasia of the hip is valuable in terms of stability, avascular necrosis, effect of age and the need for further procedures.
Out of the ninety Children with DDH received within two years, twenty five of them needed open reduction through Ludloff’s approach; they were subjected to full assessment including detailed history and clinical examination in addition to radiographic evaluation. The remaining sixty five patients underwent closed reduction and hip spica cast application.
Regarding those patients treated by open reduction, seven were males while eighteen were females, sixteen of them are below one year of age, trials of closed reduction under general anesthesia with arthrographs taken during the procedure to obtain the optimal range of hip movement with no benefit, so they were operated upon through the medial (Ludloff) approach.
We found that this approach have more easy access to the hip joint, no need for blood transfusion and shorter time (20-30) minutes for each hip in relation to other approaches in the same age group. Serial follow up clinically and radiographically was performed to all patients.
Postoperative complications included six hips with avascular necrosis of femoral head according to Kalmachi and MacEwan classification. No redislocation and infection was recorded. In conclusion, this method provides a stable and concentrically reduced hip.
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