Results of closed reduction and casting older than 18 months of age patients with developmental hip dysplasia

Objective: In this study, we aimed to investigate the clinical and radiological results of closed reduction and casting older than 18 months of age patients with developmental hip dysplasia to discuss the influence of success of the technique. Materials and Methods: The results of 20 hips of 13 patients (2 male, 11 female) who were treated with closed reduction and casting between March 2011 and June 2014 at Bezmialem University School of Medicine, in the department of Orthopaedics and Traumatology were evaluated. The involvement was at the right hip in 4 hips, at left in 2 hips and bilateral in 7 hips. At the time of closed reduction the mean age of patients were 19,4 months and the mean follow-up period was 27,7 months. In the radiological evaluation of patients at the prereduction period; degree of displacement described by Tönnis, acetabular index angle, acetabular angle and femoral neck shaft angle were used. In the follow up period in addition to acetabular index; acetabular angle, CE angle of Wiberg and femoral neck shaft angle also were used. And to assess the radiological consequences, Tönnis's statements are generated according to the values of normal population standard deviation values were used. Results: In 12 hips (60%) reduction that was considered as stable intraoperatively so cloesed reduction and spica cast procedure was achieved. However; due to treatment failure 8 hips (40%) were excluded and because of residual hip dysplasia secondary pelvic osteotomy requirements were performed an avarage of 5,2 months after the first closed reduction and spica cast procedure. In the last follow up in regard to degree of displacement described by Tönnis, there was 2 Tönnis type 1, 6 Tönnis type 2, 7 Tönnis type 3 and 5 Tönnis type 4 hips. At one sided hips, when the normal hips' acetabular index were compared with dislocated side; the normal hips' acetabular index were lower than the dislocated side. The normal hips' pre-reduction average AI measurement was 27,75 but last average AI measurement was 18,75 degree, nevertheless the dislocated hips' pre-reduction average AI measurement was 39,25 degree and last average AI measurement was 22,5 degree. Conclusions: In the light of this study we concluded that, considering the radiological measurements, closed reduction and hip spica cast procedure should not be performed in older than 18 months of age. And always keep in mind, the higher degrees of dysplasia according to Tönnis at the beginning of treatment we need to be cautious about secondary dysplasia and required asetabular osteotomies in follow-up period. Key words: Developmental dysplasia of the hip, older than 18 months of age, closed reduction, hip spica cast.