Congenital hip luxation:therapy
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In the arthrography (click on arthrography if you want to see the images) we see the increased distance of the femural head from the acetabulum floor. With conservative treatment reduction is not possible. We gave indication to open reduction. The question was still: when? We don't think that waiting is useful and we are not convinced that waiting for some more months will really reduce the head necrosis rate, this depends much more on the surgical procedure.
supine position, with a short incision distal to the superior anterior iliac spine (Hueter approach). Exposition of the hip capsule between tensor fasciae latae and sartorius.
Incision of the hip capsule on the anterior site. Reduction was not possibile due to the hypertrophic ligamentum rotundum: the epiphysis was flattened because of the compression against the lig. rotundum (waiting will worsen the compression effects always). Resection of the lig. rotundum and small incisions of the labrum let reduce the hip epiphysis. The secure position was the frog leg position. We sutured the capsule in redundancy into the correct position. Closure of the fascia latae and skin closure with resorbable sutures. Application of a cast with the frog leg position (not Fettweis).
After the plaster we did RMN control of the hip, which showed a correct reduction.
Cast was changed after 4 weeks - hip was stable, we repeated anyway a RMN exam to ashure the correct position.
After these 2 months of rigid immobilization in a cast, we continued treatment with Pavlik and ecographic exams to accertain correct hip development