Today’s case: 18 month old child. HX OF FAILED CLOSED REDUCTION AT 9 months of age. Open reduction pelvic osteotomy adductor tenotomy and hip spica done. No tension at reduction so no femoral shortening. I’d like to mention the Saudi experience in this common pathology here=

It’s not uncommon for DDH still comes late in our clinics with some of them already managed with braces and closed reduction trials in other hospitals. The tendency is to go for an open reduction pelvic osteotomy in a younger age to solve multiple social and logestic issues.

The one surgery option is more popular as the deformity show in a more severe type “high Tonnis dislocation, remodeling capacity is not satisfying in a significant number requiring later pelvic osteotomy” pushing more orthopeds surgeons to do the pelvic osteotomy in the same time

The to go for osteotomies in most surgeons here tends to be a pemberton osteotomy for anterior deficiency and a San Diego for posterior and global deficiency and also for anterior as well for its fans “one osteotomy to cover all defects”

Another interesting fact in the Saudi experience is to go only for xrays post op. CT is reserved usually for revision cases pre and post. Intra-op findings is the main indicator for the type of pelvic osteotomy/ need to shorten the femur and derotation osteotomy

We unfortunately don’t write down our protocols and we have a very limited literature regarding this pathology but fortunately more data is started to be collected and published. Do you have a different approach to this very controversial pathology ???? I’d like to read a few.