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The Early Detection and Management of Unstable Concentric Closed Reduction of DDH With Percutaneous K-wire Fixation in Infants 6 to 12 Months of Age

Alsiddiky, Abdul Monem Mohamed SSC-Orth; Bakarman, Khalid Abdulla ABOS; Alzain, Kholoud Omar SSC-Orth; Aljassir, Fawzi Fahad FRCSC; Al-Ahaideb, Abdulaziz Suliman MD; Kremli, Mamoun Khalid FRCS, Glas; Zamzam, Mohammed Medhat MD, PhD, MSc; Mervyn Letts, Robert MD, FRCSC

doi: 10.1097/BPO.0b013e318236b1fc
Hip/Femur

Background: In some infants with developmental dysplasia of the hip, concentric closed reduction, although initially achievable, cannot be maintained even by casting because of a deficient posterior acetabular wall. Usually, these hips will redislocate in the cast and a rereduction will be necessary, often requiring an open reduction subsequently.

Methods: A 3-year retrospective review of 88 infants, (M/F; 14/74) 6 to 12 months of age with 124 dislocated hips, was conducted to assess the efficacy of percutaneous Kirschner wire fixation in achieving permanent hip stability. A “hip-at-risk” instability test was developed to detect potentially unstable hips at the time of closed reduction that might redislocate in the hip spica cast, and these hips were stabilized with a percutaneous K-wire through the greater trochanter into the pelvic bone.

Results: The hip instability test was positive in 27 hips and negative in 97. Percutaneous K-wire fixation was used to stabilize 21 hips with a positive hip instability test. All 21 unstable hips that were stabilized with the K-wire technique maintained their concentric reduction and went on to stable development. No K-wire breakage was encountered and only 1 superficial pin tract infection occurred.

Conclusions: K-wire stabilization of unstable closed reductions is a safe, reliable technique for maintaining concentric hip reduction in infants 6 to 12 months of age with developmental dislocation of the hips.

Level of Evidence: Level II retrospective study.

Department of Orthopaedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Study was conducted by the Orthopaedic Surgery Research Chair group King Saud university, Riyadh, Saudi Arabia.

The authors declare no conflict of interest.

Reprints: Mohammed Medhat Zamzam, MD, PhD, MSc, Department of Orthopaedics, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Saudi Arabia. E-mail: mmzamzam@yahoo.com.

© 2012 Lippincott Williams & Wilkins, Inc.