Title

Comparison of outcomes of open reduction versus open reduction salter osteotomy for developmental dysplasia of the hip (DDH) among children at French Medical Institute for Children, Kabul, Afghanistan

Date of Award

1-2017

Document Type

Thesis

Degree Name

Diploma in Paediatric Orthopaedics

First Supervisor/Advisor

Ezatullah Faiz

Department

French Medical Institute for Children (FMIC)

Abstract

Background: Developmental Dysplasia of the Hip (DDH) consists of either subluxation or dislocation of femoral head from acetabulum and acetabular dysplasia. The ratio of left side hip to right is 3:1. There are several kinds of treatments for DDH globally, and conservative treatment is one of the best methods with a better outcome than surgical treatment.
Objective: The aim of this research study is to compare the outcomes of Open Reduction versus Open Reduction Salter Osteotomy with regard to length of stay, complications and family satisfaction among children with DDH at FMIC, Kabul, Afghanistan.
Methodology: A retrospective cohort study design was employed. Records of 166 participants who underwent Open Reduction and Open reduction Salter Osteotomy at FMIC hospital were reviewed. The data was collected from the available records during the period of 2010 to 2015. Chi-square test of independence and T-test for two independent samples were run to determine an association between two categorical variables and compute mean difference between categorical and continuous variables for two types of surgical procedure for DDH respectively. In addition, t-test for two dependent samples was also run to compare the mean difference of Pre-operation and Post-operation AI. All the ethical principles were followed throughout the study process.
Result: The research findings revealed that there is a difference in outcomes of Open Reduction versus Open Reduction Salter Osteotomy. There was a meaningful difference of Pre-operation and Post-Operation AI for DDH patients (p-value <0.001). Hospital length of stay for Open Reduction group was relatively low (p-value <0.001). The rate of development of complications was higher in Open reduction group as compared to Open reduction Salter osteotomy. Residual dysplasia is more common in open reduction group, 16 participants (19.27%) as compared to open reduction salter osteotomy 9 (10. 84%). In open reduction group only 1 (0.6%) of the participants had subluxation, and 2 (1.2%) others developed femoral head AVN. On the contrary, in the open reduction salter osteotomy group, 1 (0.6%) participant had developed subluxation and 5 (3%) had developed AVN and majority of participants 132(79.5%) had not developed any complications. Half of participants’ families 101 (60.8%) were strongly satisfied, followed by 62 (37.3%) satisfied, and while 3 (1.8%) were dissatisfied with two types of surgical treatment methods. 132 (79.5%) of participants had excellent outcome, 25 (15.1%) good, 2(1.2%) and 7 (4.2%) poor outcome.
Conclusion: The research study revealed that there is difference in the outcomes of Open Reduction versus Open Reduction Salter Osteotomy with regard to length of stay, pre and post-operation acetabular index, complication and outcomes of treatment. Open Reduction along with Salter Osteotomy is an excellent method for successful surgical outcomes after age of 18 months.

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