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Abstract
In children older than 6 months, achieving a concentrically reduced hip while minimizing complications is more challenging. Bracing, traction, closed reduction, open reduction, and femoral or pelvic osteotomies are frequently used treatment modalities for children aged 6 months to 4 years. [17]Although most often considered for children older than 18 months, an open reduction is indicated for any hip in which a concentric, stable reduction cannot be achieved by closed means. A variety of approaches may be used; the location of the skin incision is of less importance than the elements of the procedure relevant to the acetabulum.. If this approach is used in bilateral cases, the procedures are usually staged at 2- to 6-week intervals. [17]Inability to perform a pelvic osteotomy or capsulorrhaphy via a medial approach generally limits its use to patients less than 12 to 18 months of age. However, a medial approach requires minimal dissection, avoids splitting the iliac apophysis, and allows direct access to the medial structures. There are several medially based approaches. The true medial approach, as originally described by Ludloff, utilizes the interval between the pectineus and the adductor longus and brevis. Ferguson [24] popularized the use of this approach in the United States and modified it to pass between the adductor longus and brevis anteriorly and the adductor magnus and gracilis posteriorly