Reducing limping by tibial lengthening along nails in adult unilateral developmental dysplasia of the hip with high dislocation
Resource
JOURNAL OF THE FORMOSAN MEDICAL ASSOCIATION v.107 n.7 pp.540-547
Journal
Journal of the Formosan Medical Association
Journal Volume
107
Journal Issue
7
Pages
540-547
Date Issued
2008
Author(s)
Abstract
Background/Purpose: Treatment of adult neglected developmental dysplasia of the hip (DDH) with high dislocation is still not established. The main concern of young patients is leg-length discrepancy (LLD), which leads to limping gait and impaired body image. Such patients usually ask for a minimally invasive treatment that can improve the LLD. Methods: Between 1993 and 2003, 17 patients with neglected DDH with high dislocation (mean age, 22.8 years) were treated by tibial lengthening using the Ilizarov external fixator over an intramedullary nail. The inclusion criteria were unmarried young adults, unilateral lesion, significant limping or unsightly gait with psychologic discomfort, marked shortening > 4 cm with the block test, and benefit from a shoe-lift. Exclusion criteria were patients older than 30 years, hip pain as the chief complaint, and compensated low hip dislocation without significant limping. Results: All 17 patients had eventual bone consolidation without further operation. The mean external fixation index was 14.2 day/cm. Bone formation was good in all patients with a mean consolidation index of 57.7 day/cm. At an average follow-up period of 7.8 years, the limping was much improved from a moderate or severe degree to a mild degree in all patients. No patients had equinus contracture. All patients were satisfied with their treatment results. There were two complications: transient loss of big toe extension and mild wound infection. Conclusion: Tibial lengthening can improve limping in adult patients with neglected DDH and high dislocation with a low morbidity. Lengthening along intramedullary nails can effectively reduce the external fixation time, improve bone formation, and prevent complications. ©2008 Elsevier & Formosan Medical Association.
Subjects
Adults
Bone lengthening
Congenital hip dysplasia
Developmental disabilities
Leg length inequality
SDGs
Type
journal article