During a closed reduction, the surgeon typically injects dye into the hip to verify whether something is holding the hip out of the correct position. A closed reduction does not require a surgeon to cut into the hip socket. The surgeon then manipulates the hip externally to bring the head of the femur into the correct position in the hip socket (acetabulum). The surgeon stabilizes the hip by applying a spica cast.
During an open reduction, the surgeon starts by injecting dye into the hip to verify whether something is holding the hip out of the correct position. The surgeon then opens the hip capsule and surgically positions the ball of the femur into the correct position in the acetabulum. After sewing up the hip, the surgeon stabilizes the hip by applying a spica cast.
A pelvic osteotomy is used when the acetabular index is not improving and there is not adequate coverage of the femur. The surgeon begins by opening the hip capsule up, hence many times the surgery is osteotomy with an open reduction. After the hip capsule is opened, the surgeon will take a wedge shaped piece of bone from the bony protuberance further up on the pelvis. This is the graft bone. Next the surgeon will cut across the pelvis slightly above the acetabulum. The bone graft will be inserted into this cut and held in place with 2 four-inch long pins. Lastly the surgeon will place a spica cast on the child which remains on up 8 weeks. The pins are taken out later, sometimes when the cast comes off and sometimes in a separate operation. The pelvic osteotomy brings the whole acetabulum (socket) down and around without changing the shape of the socket. There are different pelvic osteotomies depending on where the surgeon opens the hip socket (anterior, medial or posterior), where exactly on the pelvis the cut is made and whether more than one cut is made. But the resulting operation is still the same.
A femoral osteotomy is performed when there is adequate coverage of the femur but still the femur can move with the possibility of dislocation. The surgeon begins by opening the hip capsule. The femur is cut all the way across just slightly below the ball area. The surgeon then rotates the top of the femur slightly around towards the acetabulum. The femur is then put back together with a plate and screws. Lastly a hip spica cast is placed on the child which remains on up to 8 weeks. The plate and screws are removed in a separate operation at a later date. The femoral osteotomy rotates the top of the femur around to fit better into the acetabulum (socket) while the bottom of the leg remains unchanged.
If you have any questions about this site or would like to make a suggestion, please contact us at hip-baby.org.