If congenital dislocation of the hip is discovered in this age group then the objective is to reduce the hip and to hold it until satisfactory acetabular development has occurred.
Reduction is undertaken as a closed procedure. This is gradual over about 3 weeks to avoid the risk of femoral head necrosis. Traction is applied to both legs and abduction increased until the legs are widely separated. This manoeuvre may be sufficient for stable concentric reduction.
Splintage: if there is concentric reduction of both hips then they are held in at least 60 degrees of flexion, 40 degrees of abduction and 20 degress of internal rotation in plaster for 6 weeks. After the plaster has been removed it is replaced by a splint that prevents adduction but allows movement.
Operation: if concentric reduction has not been achieved then open reduction is required. If significant internal rotation is required, a corrective osteotomy may be required. An inadequate roof above the femoral head is resolved by making a shelf above the acetabulum, or by an innominate osteotomy operation.
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