Abstract
The aim of this research was to elaborate indications for application of some methods of surgical treatment of DDH in teenagers.
There are some significant problems with surgical treatment of DDH in teenagers. The most serious one is that the results of routine reconstructive methods usually satisfy neither the patients nor the orthopaedists. In addition, in most of the cases it is too early for total hip arthroplasty.
From 1985 to 1996, we operated twenty teenagers with late stages of DDH. Group A was eight patients (12 to 14 years old) with marginal hip luxation (acetabulum angle was more than 40°). Group B was seven patients (10 to12 years old) with iliac hip dislocation (acetabulum angle was more than 50°) and Group C was five patients (11 to 14 years old) with iliac hip dislocation (plane acetabulum).
In Group A we performed our first two-stage method of surgical treatment. For the first stage we performed corrective transtrochanteric femur osteotomy (AO plate fixation) and partial acetabuloplasty, and corrected not more than half of the acetabulum angle deficiency. The second stage was performed four to six months later. We removed the femur AO plate and again performed a partial acetabuloplasty. A spherical acetabulum with normal angle and stable hip joint were the results of this method.
In Group B we performed our second two-stage method of surgical treatment. For the first stage we performed a corrective and shortening (2 to 3 cm) transtrochanteric femur osteotomy (AO plate fixation), open reduction of the hip and partial acetabuloplasty and corrected not more than half of acetabulum angle deficiency. The second stage was performed 4 to 6 months later and we removed the femur AO plate and performed a Salter osteotomy. A spherical acetabulum with normal angle and a stable hip joint were also the results of the application of this method.
In Group C we performed the well-known Ilizarov technique of femur reconstruction (modification of Schanz osteotomy with correction of femur shortening). Normalisation of gait and reduction of the Trendelenburg sign were the results of the application of this method.
The results of these methods were studied 3 to 10 years after the end of postoperative rehabilitation. Good results were obtained in 16 cases, satisfactory in four (one in Group A, two in Group B and one in Group C).
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
