Slide 011 — DDH presenting after 18 months

Clean FRCS notes with inline figures

•Presented >18mths

**Fig 1.** Radiograph / imaging - radiographtop left

•XR (>6m) of this patient’s pelvis, skeletally immature with open triradiate cartilage. The most obvious finding is a dislocated left hip. The femoral epiphyseal looks small, and the neck shaft angle is more than the right side. The tear drop is poorly formed and the acetabulum margins are not well defined. The Shenton's line is obviously broken

•Further ix: XR von rosen views to check if reducible

•DDx: NM hip dislocation

•Aim: stable, congruent, concentric reduction without too much tension to have painless hip with good ROM. Prevent complications

Treatment:

•OR +/- osteotomy

Anterior approach for this case

Reason:

•Better exposure

•Can do capsulorrhaphy and pelvic osteotomy

Avoid complication of injuring medial femoral circumflex

•Can attack intraarticular obstacles to relocation

•Precautions: iliac apophysis and stripping of abductors, more bleeding

•Femoral osteotomy if need to maintain reduction in IR and abduction, in the form of VDRO +/- shortening

•Acetabular osteotomy if need to maintain in flexion

•Choice of which type of osteotomy (age)

•2-10 yrs

•Redirection – Salter, triple

•Reshape – Pemberton for AL deficiency (Dega for PL deficiency)

•10-14 yrs

•Open triradiate cartilage – Triple

•Close triradiate cartilage – Ganz PAO

•>14yo

•Chiari / Shelf procedure, as no remodeling

•+/- Shortening in >3 yo (chronic shortening → contracted soft tissue → increase tension on femoral head after reduction → AVN)

#	marL	indent	logical	original note line
1	None	None	0	Presented >18mths
2	0	0	0	XR (>6m) of this patient’s pelvis, skeletally immature with open triradiate cartilage. The most obvious finding is a dislocated left hip. The femoral epiphyseal looks small, and the neck shaft angle is more than the right side. The tear drop is poorly formed and the acetabulum margins are not well defined. The Shenton's line is obviously broken
3	None	None	0	Further ix: XR von rosen views to check if reducible
4	0	0	0	DDx: NM hip dislocation
5	0	0	0	Aim: stable, congruent, concentric reduction without too much tension to have painless hip with good ROM. Prevent complications
6	None	None	0	Treatment:
7	None	None	0	OR +/- osteotomy
8	None	None	0	Anterior approach for this case
9	None	None	0	Reason:
10	171450	-171450	1	Better exposure
11	171450	-171450	1	Can do capsulorrhaphy and pelvic osteotomy
12	171450	-171450	1	Avoid complication of injuring medial femoral circumflex
13	171450	-171450	1	Can attack intraarticular obstacles to relocation
14	171450	-171450	1	Precautions: iliac apophysis and stripping of abductors, more bleeding
15	None	None	0	Femoral osteotomy if need to maintain reduction in IR and abduction, in the form of VDRO +/- shortening
16	None	None	0	Acetabular osteotomy if need to maintain in flexion
17	None	None	0	Choice of which type of osteotomy (age)
18	None	None	0	2-10 yrs
19	228600	-228600	1	Redirection – Salter, triple
20	228600	-228600	1	Reshape – Pemberton for AL deficiency (Dega for PL deficiency)
21	0	0	0	10-14 yrs
22	228600	-228600	1	Open triradiate cartilage – Triple
23	228600	-228600	1	Close triradiate cartilage – Ganz PAO
24	0	0	0	>14yo
25	228600	-228600	1	Chiari / Shelf procedure, as no remodeling
26	0	0	0	+/- Shortening in >3 yo (chronic shortening → contracted soft tissue → increase tension on femoral head after reduction → AVN)

#	semantic level	section?	rewritten line
1	1		Presented >18mths
2	1		XR (>6m) of this patient’s pelvis, skeletally immature with open triradiate cartilage. The most obvious finding is a dislocated left hip. The femoral epiphyseal looks small, and the neck shaft angle is more than the right side. The tear drop is poorly formed and the acetabulum margins are not well defined. The Shenton's line is obviously broken
3	1		Further ix: XR von rosen views to check if reducible
4	1		DDx: NM hip dislocation
5	1		Aim: stable, congruent, concentric reduction without too much tension to have painless hip with good ROM. Prevent complications
6	0	yes	Treatment:
7	1		OR +/- osteotomy
8	0	yes	Anterior approach for this case
9	0	yes	Reason:
10	1		Better exposure
11	1		Can do capsulorrhaphy and pelvic osteotomy
12	0	yes	Avoid complication of injuring medial femoral circumflex
13	1		Can attack intraarticular obstacles to relocation
14	1		Precautions: iliac apophysis and stripping of abductors, more bleeding
15	1		Femoral osteotomy if need to maintain reduction in IR and abduction, in the form of VDRO +/- shortening
16	1		Acetabular osteotomy if need to maintain in flexion
17	1		Choice of which type of osteotomy (age)
18	1		2-10 yrs
19	1		Redirection – Salter, triple
20	1		Reshape – Pemberton for AL deficiency (Dega for PL deficiency)
21	1		10-14 yrs
22	1		Open triradiate cartilage – Triple
23	1		Close triradiate cartilage – Ganz PAO
24	1		>14yo
25	1		Chiari / Shelf procedure, as no remodeling
26	1		+/- Shortening in >3 yo (chronic shortening → contracted soft tissue → increase tension on femoral head after reduction → AVN)

011. DDH presenting after 18 months

Clean FRCS notes with inline figures

Treatment:

Anterior approach for this case

Reason:

Avoid complication of injuring medial femoral circumflex

Direct Q&A

Treatment:

Anterior approach for this case

Reason:

OR +/- osteotomy

Can attack intraarticular obstacles to relocation

Raw speaker-note hierarchy audit

Improved semantic hierarchy used for the study notes