Arrange the options in sequence as part of surgical intervention for DDH:a. Capsulotomyb. Locate the acetabulum by tracing ligament of teresc. Relocate the femoral head in acetabulumd. Derotation femoral osteotomy
Ans. B (a-b-c-d) Capsulotomy- Locate the acetabulum by tracing ligament of teres- Relocate the femoral head in acetabulum- Derotation femoral osteotomy.(Ref: Text book of Orthopedics by John Ebnezar 5th Ed; Page no-499)Treatment of DDH According to Age GroupsNewborn (6 Months)6-18 MonthsToddler (18-36 Months)Child (3-8 Years)Juvenile and YoungAdults (8-18 Years)Hold if need pullPull and holdBreak and holdOpen and breakOpen and replace* Pavlik harness and von Rosen splint are applied for 2 months. Later wean by removing it 2 hours/day doubled every 2-4 weeks until device is worn in the night only. Night bracing is continued till X-rays are normal.X-ray: are taken at1 month6 months1 year intervalsIf dislocation persists for 6-8 weeks, abandon this program and institute* Traction* Closed reduction* CastingIn this age group harness is not successful. The recommended regime as follows:* Preoperative traction* Adductor tenotomy* Closed reduction and arthrogram* Hip spica after confirmation of stable reduction. Desired position of the hip joint is human position (i.e. 95deg flexion and 40deg abduction at the hip)* Open reduction in child less than 18 months is done when closed reduction fails by using the Bikini skin incisionHere open reduction is combined with femoral or pelvic osteotomy or both and is the treatment of choice. Femoral osteotomy is tried first for untreated CDH and is useful in less than 8 years of age Pelvic osteotomy. The following varieties is described:* Salter's uses symphysis pubis as the hinge. Useful between 18 months and 6 years* Pemberton Uses triradiate cartilage as the hinge. Useful between 1 and 10 years of age.* Steel (Triple innominate osteotomy) Useful in older children when symphysis pubis and triradiate cartilage are fused.* Shelf operations Here acetabulum is extended anteriorly. Laterally and posteriorly. Useful in CDH which have recurred after reduction.* Chiari's oscotomy Here medial displacement of the distal fragment is done usually as a last resort. Useful in children Over 4 year of age.Here open reduction is the treatment of choice and is usually followed with femoral shortenings (Klisic and Jankovic) and if necessary, pelvic osteotomy.Depending on the situation, the following procedures are chosen:* Femoral shortening with pelvic osteotomy.* THR when osteoarthritis develops.* Rarely arthrodesis
b-a-c-d
a-b-c-d
c-b-a-d
c-a-d-b
Miscellaneous