Pediatric orthopedics. Greater trochanteric advancement for the treatment of coxa brevis associated with congenital dislocation of the hip

A patient has been presented with congenital dislocation of the left hip having initial treatment at age three months. The treatment included closed reduction and immobilization in a spica cast. Experience has shown that closed reduction without the benefit of prereduction traction is associated with a high incidence of avascular necrosis probably due to vascular occlusion. The chondroepiphysis is most vulnerable to ischemic injury in the first six months of life. The patient then presented at age ten years with a nonpainful gluteus medius limp and a radiograph demonstrating the residual deformity of total ischemic damage of the epiphysis and physis. The patient also had a 3.5 cm limb length discrepancy. The natural history of this hip is that of early degenerative arthritis. A distal femoral epiphysiodesis was done on the contralateral side to treat the limb length discrepancy. A distal and lateral greater trochanteric advancement was done to lengthen the abductor muscle length, which improved the abductor muscle contraction and eliminated the limp. This also lengthened the abductor lever arm, which reduces the force across the hip joint and delays the onset of degenerative arthritis.