Risk factors for additional surgery after closed reduction of hip developmental dislocation.

PURPOSE: to evaluate the risk factors for additional surgery after closed reduction of hip developmental dislocation Methods : closed reduction for developmental hip dislocation was performed on 72 patients, with a total of 82 hips (10 bilateral). Were included only patients with irreducible hip dislocation who were treated by overhead traction followed by closed reduction under general anaesthesia and spica casting. The mean age at the time of closed reduction was 10 months, with 82% of dislocation diagnosed after the age of 6 months. In 28 hips (34.1%), no additional surgical procedure was necessary, while 54 hips (65.9%) needed an additional surgery, consisting in Salter osteotomy in 40 hips (48.8%) or open hip reduction in 14 (17.1%).

RESULTS: risk factors for the need of additional surgery were: older age at the time of reduction, male sex, high grade of hip dislocation (Tönnis grade 3 and 4, versus grade 1 and 2), and quality of hip reduction. All the patients older than 17 months at the time of closed reduction needed additional surgery. Bilateral hip dislocation had poorer Severin grading than unilateral dislocation. Poorer Kalamchi scoring was associated with older age and with the presence of the cephalic nucleus at the time of reduction.

CONCLUSION: this study confirmed delayed diagnosis of hip dislocation leads to a more extensive treatment with poorer issue.