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jsmc-10069


EFFECT OF WALKING OF THE CHILD INDEPENDENTLY ON THE DEVELOPMENTAL DYSPLASIA OF THE HIP

Jager Omar Ahmed *


* Department of Surgery, Faculty of Medical Sciences, University of Duhok, Kurdistan Region, Iraq.


Submitted: 20/8/2014; Accepted: 2/12/2014


ABSTRACT


Background

In developmental dysplasia of the hip a number of pathological changes develop, some of them perhaps reflecting a primary dysplasia of the acetabulum and / or the proximal femur, but most of them are results of adaptation to persistent instability and abnormal joint loading. After weight bearing commences, these changes are intensified. Most children begin to walk independently near their 1st year birthday; some do not walk until 18 month of age. At this age group the classical treatment of a dislocated hip is closed reduction with spica cast then abduction splint. Re-displacement is one of the complications of the treatment of developmental dysplasia
of the hip.

Objective

The aim is to assess the effect of independent walking of a child on the future treatment of a missed dislocated hip whether it increases the risk of failure of treatment by re-displacement of the hip or not.

Patients and Methods

This study included those children who had missed dislocation or subluxation of the hip and they were at the expected period of beginning of walking independently (age 12-18 months). They were 87 patients with 131 dislocated or subluxated hips. Patients were divided into five groups: Group 1: still not walking independently, Group 2: walking independently for less than 1 month, Group 3: walking for 1-2 months, Group 4: walking for 2-3 months and Group 5: walking for more than 3 months.

Results

Most of patients in Group 1 had bilateral developmental dysplasia of the hip (DDH) (63.3%) and also in Group 5 (80%), while in Group 2, 3 and 4 the DDH were more common in one side (75%, 71.4% and 72.7% respectively ). From the total number of patients who had been included in this study, 21 hips out of 131 showed signs of re-displacement with an incidence of failure of 16 %. There were 3 hips in Group 1, 1 hip in Group 2, 4 hips in Group 3, 6 hips in Group 4 and 7 hips in Group 5.

Conclusion

Walking of a child independently is associated with an increased risk of failure of closed reduction in patients having developmental dysplasia of the hip between the age of 12-18 months specially after 2 months from walking.

KEYWORDS

Walking, Developmental dysplasia of the hip, Re-displacement.