anterior approach

Two groups of dislocated hips

1.  Late presenters

2.  Failures of splint in those < age 6/12

Options

1.  Adductor tenotomy + closed reduction

- most surgeons will attempt this initially

- risk of AVN wilth forceful reduction / excessive abduction

2.  Open Reduction

- for failure of closed reduction

Non operative Management

Indications

< 20^o sagittal

< 30^o coronal

< 3 cm of shortening

Options

Xray Assessment

A:  Alignment

B:  Bony

C:  Canal

D:  Disc

S:  Soft tissues

Goals of surgery

1.  Correct deformity

2.  Restore stability

3.  Decompress neural elements if required

MRI

Advantage

- defines level of conus

- may need anterior rather than posterior surgery if lesion above conus

Via the carotid triangle

SCM / posterior belly digastric / superior belly omohyoid

Indication

Exposes inferior body C2 - T1

Position

1.  Supine in tongs

2.  Sit on head board with head taped and slightly extended

Table 30° up

Turn head away from side of incision

Which Side