On the treatment of high unilateral congenital hip dislocation in older children: Minimizing the inequality of limb length

BACKGROUND: Treatment of high congenital hip dislocation in older children remains controversial in terms of the choice of the method of reducing the femoral head to the level of the acetabulum. In most cases, significant shortening of the hip is performed to eliminate dislocation, which leads to secondary deformities. 
AIM: This study aimed to evaluate the results of treatment of high hip dislocation in older children, in which pre-reduction skeletal traction and economical shortening of the femoral segment are rationally combined to lower the femoral head. 
MATERIALS AND METHODS: From 2011 to 2021, we observed 13 patients aged 513 years with grade 4 high unilateral congenital hip dislocation according to the international Tonnis classification. 
RESULTS: The treatment results were traced for 19 years. When assessing hip joint function according to McKay criteria, excellent and good results were obtained in 84.6% of the patients. X-ray evaluation by Severin also included 84.6% in groups 1 and 2. Signs of avascular necrosis of the femoral head according to the criteria of Kalamchi and MacEwen were detected in four patients (group 1, n = 2; group 2, n = 1; group 3, n = 1). The difference in the length of the n/limbs in eight patients was 1.5 cm on average, and in the remaining children, a clinically insignificant asymmetry was observed in the length of the n/limbs, i.e., 0.50.7 cm. 
CONCLUSIONS: The choice of the method of surgical correction of high hip dislocation largely depends on the age of the child. In children aged 5 years, with a significant displacement of the femoral head and limb shortening, a combination of reduction methods is rational, i.e., use of preoperative skeletal traction with economical shortening of the femoral segment, open reduction, and correction of the acetabulum. The optimal combination of the distraction method and surgical correction makes it possible to achieve successful reduction and a good functional result.