Introduction: A combined procedure including open reduction, femoral shortening osteotomy, and an acetabular procedure is often necessary to obtain a desirable result in children of walking age who have a high-riding hip dislocation.
Step 1 surgical approach: A careful approach to the femoral head and acetabulum is required to avoid injury to nerves, vessels, and cartilage.
Step 2 explore the hip joint: Make sure to find the true acetabulum and remove all obstacles to femoral head reduction.
Step 3 femoral head reducibility: Check the reducibility of the femoral head in different positions through a full range of hip motion.
Step 4 first femoral osteotomy: Expose the proximal part of the femur subperiosteally and make necessary markers for determining the amount of shortening and rotation at the time of osteotomy.
Step 5 hip joint stability: Check femoral head reduction stability with the proximal end of the osteotomized femur.
Step 6 femoral shortening: Decide the amount of shortening and rotation for the best femoral head reduction.
Step 7 pemberton acetabuloplasty: In cases with a dysplastic acetabulum and inadequate femoral head coverage after reduction, perform a Pemberton osteotomy.
Step 8 postoperative management: Apply a hip spica cast, which the patient wears for six weeks; then switch to a hip abduction brace.
Results: The patient shown in Figures 26 through 29 and Video 5 was a three-year and six-month-old girl with bilateral developmental dysplasia of the hip that was discovered late (Figs. 26 and 27).IndicationsContraindicationsPitfalls & Challenges.