Reduction of a @entity572 due to developmental XXXX . Implications for the need for future surgery.

@entity1 @entity4094 @entity353 @entity39 @entity572 @entity717 @entity1141
BACKGROUND: Recent reports on the treatment of a @entity572 due to developmental @entity1141 have documented conflicting data on the importance of the ossific nucleus in the development of @entity39 . @entity353 until the ossific nucleus is present bypasses the time-period of maximal osseous remodeling of the hip, thereby possibly increasing the need for future operations. We hypothesized that hips with an ossific nucleus are more likely to have subsequent reconstructive procedures. METHODS: A retrospective review of the medical records at two tertiary-care @entity1 's hospitals was completed to identify all @entity1 who had had reduction of a @entity572 due to developmental @entity1141 , performed between 1979 and 1993, when they were less than two years old. @entity1 were excluded if the medical records or radiographs were inadequate, the duration of follow-up was less than three years after the final reduction, a previous reduction had been performed at an outside facility, or the @entity1 had a @entity4094 or a teratologic dislocation. We identified 124 @entity1 (153 hips) who satisfied the criteria for inclusion. The average age at the time of the reduction was eleven months, and the average duration of follow-up was 7.2 years. RESULTS: Overall, fourteen of the sixty-three hips without an ossific nucleus had a reconstructive procedure: thirteen had a @entity717 of the proximal part of the femur and one had a combined pelvic and varus rotational femoral osteotomy. Forty of the ninety hips with an ossific nucleus had a reconstructive procedure: twenty-seven had a @entity717 , eight had a pelvic osteotomy, and five had a combined pelvic and @entity717 (p < 0.05). In addition, secondary reconstructive procedures were performed in 17% (ten) of the fifty-nine @entity1 who were less than six months old and in 35% (thirty-three) of the ninety-four @entity1 who were at least six months old, which was a greater than twofold increase. The effect of age was further emphasized at the other age cutoff points. CONCLUSION: Delaying the reduction of a dislocated hip until the appearance of the ossific nucleus more than doubles the need for future surgery to make the hip as anatomically normal as possible. Despite finding a slight increase in the rate of @entity39 after reduction of the hips without an ossific nucleus, we advocate early reduction of a dislocation of a hip due to developmental @entity1141 to optimize the development of the hip with the minimum number of operations
