John H. Wedge, OC, MD, FRCS(C) and Robert B. Salter, CC, MD, FRCS(C)
For children seen with developmental dislocation of the hip after the age of eighteen months, Robert B. Salter, CC, MD, FRCS(C) devised, in 1957, a protocol of preoperative traction, open reduction, and capsulorrhaphy combined with a new procedure of innominate osteotomy to redirect the deficient acetabulum. Good results were reported for this group at ten to fifteen years postoperatively and again at fifteen to thirty-three years. Others have reported improved results with innominate osteotomy for this indication. Perhaps uniquely in a series with this duration of follow-up, the operative technique has not been altered. The main change in protocol concerns preoperative traction, which is generally no longer practical. All of the children in this study had a minimum period of two weeks of traction, to stretch the soft tissues and decrease joint pressure after reduction, but experience has shown that this may not be essential for a safe reduction in younger children. In older children, instead of prolonged traction in the hospital, the authors currently recommend femoral shortening, which they believe may decrease the rate of osteonecrosis. In summary, this method of open reduction and innominate osteotomy for developmental dislocation of the hip presenting after eighteen months of age can be expected to result, on the basis of data derived from validated and reliable measures, in the following outcomes at forty-five years after the index procedure. In this JBJS video supplement to the article, Doctor Salter provides surgical technique pearls as Doctor Wedge demonstrates the key steps of the procedure.
Material Covered
- Indications
- Contraindications
- Historical Footage
- Surgical Pearls
- Avoiding Complications
See the Corresponding JBJS Article:
- Simon R. Thomas, John H. Wedge, and Robert B. Salter
- Outcome at Forty-five Years After Open Reduction and Innominate Osteotomy for Late-Presenting Developmental Dislocation of the Hip
J. Bone Joint Surg. Am., Nov 2007; 89: 2341 – 2350 [Article]
- John H. Wedge, Simon R. Thomas, and Robert B. Salter
- Outcome at Forty-five Years After Open Reduction and Innominate Osteotomy for Late-Presenting Developmental Dislocation of the Hip: Surgical Technique
J. Bone Joint Surg. Am., Oct 2008; 90: 238 – 253. [Article]
Specifications
- Total Run Time: 18:36 minutes
- Catalog Number: 4077
- VJO Publication Date: June, 2008