IJOCP | March 2015| Volume 2| Issue 1 | Page 16
Conference: VVX Congresano  Mexicano De Ortopedia Y Traumatologia  FEMECOT  

Authors: Dr.Douglas Colmenares

Authors Affiliations: Hospital Regional de Alta EspecialidaddelBajío

BlvdMilenio 130. SanCarlos La Roncha. Leon, Gto. Mexico.

Address of correspondenceE Mail: douglas_cb@yahoo.com


Since open reduction in CDH is a regular procedure for pediatric orthopedic surgeons in our country, we recommend to individualize the management (a la carte surgery)and not as a protocol of surgery for all patients.

The regular approach for the 36 months old and younger patients should be the internal inguinal or Ludloff incision, since upper dislocations may need anterior approach to allow visualize all anatomical structures.

It is believed that adductor and psoas tenotomy may decrease the capsular tension forces after open reduction in order to avoid avascular necrosis (AVN) after the procedure.  It was described in attempt to diminish time required to do so with skeletal traction and ease the hip reduction. The benefit and usefulness of this procedure is debated, and to the best of our knowledge there is not studies to assure it.

Iliopsoas tendon may be a dislocating factor, since is described in many revision surgeries, but it also may be an stabilizing role when the hip is on the soquet. It may help to decrease the distance from the round of femoral head to the acetabulum.

There is some studies in literature (Univ Pensil OrthopJour, 2014 (24) 42-44) that describe iatrogenic dislocation in adult hip after some monts of arthroscopic psoas tenotomy for coxa saltans, showing and sugesting how this structure has an stabilizing role in the hip.

In our center, we have done open reduction in 128 hips from april 2008, until february 2012, in an individualized procedure for each patient. In 58% of hips we have done psoas and aductor tenotomy, in 25% only psoas tenotomy, in 13% none and only adductor tenotomy in 4%.

All of our groups have the same incidence in AVN or re-dislocation.

In the same order of ideas, in 1990 was described (J Bone Joint Surg Br. 1990 Jul;72(4):557-62) a similar group of patients with surgery made on 210 hips, reporting 47% of AVN, without difference in skeletal traction time, aductor tenotomy or without tracction. In longer and recent study ( J PedOrthopB 2013, Vol 22 No 3)  there is predictive value for AVN after reduction in CDH only when age is older than 24 months old at the time of surgery, and not with or without aductor or iliopsoas tenotomy.

There is not evidence that iliopsoas or aductors play a role for re-dislocation, but there is evidence that transverse ligament, dismorphic head or excesive anteversion are (J PediatrOrthop, 1989 (9):6: 633-39) (J Pediatr Orthop 2011;31:232–239).

In conclusion, we must not assume that iliopsoas and aductors are part of a routine for open reduction of hip.

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