External Fixator Stabilization Following Open Reduction and Combined Pelvic and Proximal Femur Osteotomy in Developmental Dysplasia Hip: A Surgical Note

Abstract

Introduction: Maintenance of hip joint reduction after combined pelvic and femoral osteotomy in developmental dysplasia of the hip (DDH) in children using a hip-spica cast has the potential to cause numerous cast-related complications. We proposed a modification of the surgical technique where the hip reduction is maintained with an external fixator to avoid cast-related complications. Methodology: The surgical technique involved the placement of Scahnz pins along the iliac crest or lateral aspects of the ilium, in the supra-acetabular region below the pelvic osteotomy site, and the proximal femur. The pins were connected and stabilized with tubular/solid rods. Six children with 10 dysplastic hips [4 bilateral and 2 unilateral, International Hip Dysplasia Institute (IDHI) grade IV] were operated on with pelvic and femoral osteotomies and external fixator construct. The fixators were removed after 8 weeks and the children were followed up at 3, 6, 12, and 18 months. Results: The average age of the children was 6.5 years (range: 4 to 11 y). After an average follow-up of 10 months, the hips were reduced with IDHI grade of I in 7 hips and IDHI grade of II in 3 hips. There were no wound complications. Superficial pin tract infections were seen in all patients but responded to topical antibiotic application. There was no unplanned visit by the parents and no one complained of perineal hygiene issues. Conclusion: The external fixator construct maintains the hip reduction in DDH and allows the osteotomy sites to heal without any wound-related complications.