Objective: Purpose of the presented prospective study is to assess the pathological soft tissues together and examine their effect on the continuation of reduction in DDH cases treated with closed or open reduction by using MRI technique.
Materials and Methods: 46 hips of 34 cases treated between 2003 and 2012 were prospectively studied. MRI was performed on all children after reduction. Kashiwagi MRI classification was made according to the posterior acetabular rim on axial images at the level of triradiate cartilage. As different from Kashiwagi, the group of patientes were divided two subgroups (2A and 2B) according to pathological soft tissue changes on MRI.
Results: 27 hips with sharp posterior acetabular rims were involved in Kashiwagi group 1. Sixteen hips with rounded and dysplastic posterior acetabular rims were involved in group 2. In these cases, 9 hips of 6 cases not diagnosed with pathological soft tissue changes obstructing reduction on MRI were included in group 2A. In addition to rounded posterior acetabular rims, 7 hips of 6 cases having at least one of the soft tissue changes such as pulvinar, transverse acetabular ligament, labrum and hypertrophy of ligamentum teres were involved in group 2B. Redislocation was observed after plaster cast in all cases in group 2B and open reduction and salter osteotomy were applied. Three hips with inverted labrum were involved in group 3.
Conclusion: Presented study provides more useful information on the course of treatment in cases where Kashiwagi's classification modification and closed/open reduction and immobilization were conducted by taking soft tissue factors obstructing reduction into consideration.
DDH, MRI, Kashiwagi, Hip.