|
Year |
2002 |
|---|---|
|
Question Number |
182. |
|
Category |
Pediatric Orthopaedics |
Question
Figure 52 shows the radiograph of a 2-year-old girl with a concentrically reduced hip. History reveals that she underwent Pavlik harness treatment for developmental dysplasia of the right hip during infancy. Despite the use of abduction bracing, she has persistent acetabular dysplasia. Management should now consist of
1- continued abduction bracing.
2- varus osteotomy of the proximal femur.
3- Chiari osteotomy
4- innominate osteotomy
5- innominate osteotomy and varus osteotomy of the proximal femur
Figures
Answer (click for answer)
Answer – 1
There is considerable evidence that residual radiographic acetabular dysplasia leads to secondary degenerative joint disease. In children between 6 months and 2 years of age, acetabular dysplasia diagnosed incidentally or as a residual result after Pavlik harnessing, open reduction, or closed reduction is often treated with a fixed abduction orthotic device. The theory behind use of the fixed abduction brace is that dysplasia is associated with mild hip instability and that the device can correct that instability. These devices can be used only if the hip is well reduced. The abduction device usually is worn full time for several months, then is worn at night and during nap time until acetabular development is normal, as measured by the acetabular index. Indications for the treatment of residual radiographic acetabular dysplasia depend on the age of the child and whether or not the patient has symptoms. The goal of treatment is to restore the anatomy to as near normal as possible by skeletal maturity. After concentric reduction is obtained and maintained, the potential for acetabular development continues for many years. However, after 4 years of age, this potential for restoration of normal anatomy decreases. For minimal residual dysplasias in children younger than 4 years of age observation can be continued, but for significant dysplasia surgical intervention should be entertained.
Reference: Lovell and Winter’s Pediatric Orthopaedics, ed 5.