1. Developmental Hip Dysplasia and Dislocation
by Stuart L. Weinstein, Scott J. Mubarak, and Dennis R. Wenger
J Bone Joint Surg Am
Volume 85(10):
October 1, 2003
©2003 by The Journal of Bone and Joint Surgery, Inc.

2. Arnold Pavlik with his leather harness, circa 1955.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.

3. Figs. 2-A through 2-D The four steps for application of the Pavlik harness.
Figs. 2-A through 2-D The four steps for application of the Pavlik harness. Fig. 2-A The chest halter is applied. The shoulder straps on the halter should cross in the back to prevent them from sliding over and down the child's shoulders. Fig. 2-B The leg stirrup straps are applied. The strap for the proximal part of the leg should be located just distal to the popliteal fossa. This strap stabilizes and controls the knee and, when properly positioned, prevents bowstringing of the anterior and posterior stirrup straps. With bowstringing, tightening of the posterior stirrup straps often produces internal rotation and adduction of the hip.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.

4. Fig. 2-C The anterior stirrup straps are attached to the chest halter.
Fig. 2-C The anterior stirrup straps are attached to the chest halter. The attachment for the anterior (flexor) stirrup straps should be located at the anterior axillary line. If these straps are placed too far medially, tightening them will cause not only flexion but also adduction of the hip. Fig. 2-D Lastly, the posterior (abduction) stirrup straps should be attached over the scapula. The position should be set to hold the hip in 90° of flexion with the posterior straps limiting adduction to prevent dislocation.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.

5. A plastic hip abduction brace can be used to stabilize a newborn's hip or can be used for older children when they begin to walk.
A plastic hip abduction brace can be used to stabilize a newborn's hip or can be used for older children when they begin to walk.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.

6. Protocol for reduction of developmental dislocation of the hip.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.

7. An infant in a cast in the human position.
An infant in a cast in the human position. The hips are in hyperflexion and moderate abduction. This provides maximum stability following closed reduction or following a procedure such as the Ludloff operation in which no capsulorrhaphy can be performed.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.

8. Cross-sectional depiction of the hip in an infant before (A) and after (B) a Ludloff procedure.
Cross-sectional depiction of the hip in an infant before (A) and after (B) a Ludloff procedure. Before the Ludloff procedure, the femoral head is lateralized as a result of capsular constriction. After the Ludloff procedure, lengthening the psoas tendon and opening of the capsule has allowed the femoral head to reduce.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.

9. Lateral view of a child in a one and one-half hip spica following anterior open reduction of developmental hip dysplasia or dislocation.
Lateral view of a child in a one and one-half hip spica following anterior open reduction of developmental hip dysplasia or dislocation. This relatively hip-extended position can be used following capsulorrhaphy and places the femur in a good position to begin weight-bearing once the cast is removed.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.

10. Diagrams illustrating the technique for anterior exposure of a dislocated hip.
Diagrams illustrating the technique for anterior exposure of a dislocated hip. A: The abductor muscles are stripped from the lateral wing of the ilium, and a space above the hip capsule is developed. B: With further retraction and dissection, a complete capsular exposure is performed. This includes exposing the anterosuperior and posterior portions of the capsule.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.

11. Diagram demonstrating the Salter-type capsulorrhaphy.
Diagram demonstrating the Salter-type capsulorrhaphy. A: Outline of the planned cut in the anterior and superior capsular area. B: Excision of the superolateral and posterior segment of redundant capsule (gray shaded area). C: Internal rotation of the capsule after the hip has been reduced. Point A, which was on the anterior aspect of the neck, is now rotated to point A′, which represents a point just distal to the anterior inferior iliac spine. The inferior capsular flap (B) is rotated medially and sutured to the periosteum of the pubis (B′). D: After careful suturing with nonabsorbable sutures. This suturing has the quality of a hernia repair.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.

12. A method for planning the derotational shortening femoral osteotomy.
A method for planning the derotational shortening femoral osteotomy. Smooth pins are placed in the greater trochanteric area and in the distal femoral condyles at an angle equal to the planned degree of anteversion correction. After derotation, the pins are parallel in the transverse plane.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.

13. Sequence of the derotational femoral shortening osteotomy.
Sequence of the derotational femoral shortening osteotomy. A: A subtrochanteric cut is made after the guide-pin and AO chisel have been inserted properly. B: Overlap method to determine the amount to shorten the femur. The femoral head is reduced in the socket for this assessment. C: Internal fixation with an appropriate blade-plate.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.

14. Figs. 12-A, 12-B, and 12-C Primary open reduction and derotational femoral shortening together with a Salter innominate osteotomy in a six-year-old child.
Figs. 12-A, 12-B, and 12-C Primary open reduction and derotational femoral shortening together with a Salter innominate osteotomy in a six-year-old child. Fig. 12-A Preoperative radiograph showing a complete dislocation of the left hip.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.

15. Radiograph made immediately after derotational femoral shortening and fixation with a blade-plate as well as a Salter innominate osteotomy to improve anterolateral coverage of the femoral head.
Radiograph made immediately after derotational femoral shortening and fixation with a blade-plate as well as a Salter innominate osteotomy to improve anterolateral coverage of the femoral head.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.

16. Radiograph made six months postoperatively.
Radiograph made six months postoperatively. The hip remained stable and well reduced.
Stuart L. Weinstein et al. J Bone Joint Surg Am 2003;85:
©2003 by The Journal of Bone and Joint Surgery, Inc.