Mean Length of Femoral Shortening Required in DDH Patients: Femoral Shortening in DDH Patients

Shahan Raza; Asad Amin; Haseeb Hussain; Umair Ahmed; Jawad Ul Haq; Shuaib Amin

doi:10.54393/pjhs.v7i10.4041

Authors

Shahan Raza Department of Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital, Lahore, Pakistan
Asad Amin Department of Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital, Lahore, Pakistan
Haseeb Hussain Department of Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital, Lahore, Pakistan
Umair Ahmed Department of Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital, Lahore, Pakistan
Jawad Ul Haq Department of Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital, Lahore, Pakistan
Shuaib Amin Quaid-e-Azam Medical College, Bahalwalpur, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i10.4041

Keywords:

Developmental Dysplasia of the Hip, Femoral Shortening, Subtrochanteric Osteotomy, IHDI Grade, Pediatric Orthopedics, Hip Reduction

Abstract

Walking-age children with developmental dysplasia of the hip (DDH) frequently exhibit severe dislocation and soft tissue contractures, making concentric, tension-free reduction difficult. However, it is still unclear exactly how much femoral shortening is necessary and what factors influence it. Objectives: The goal is to ascertain the average length of femoral shortening needed for open reduction in pediatric patients with DDH and to find radiographic and clinical indicators of the extent of shortening. Methods: From February to August of 2025, a descriptive observational cohort study was carried out. There were 46 kids (52 hips) with IHDI grades III–IV DDH. Standard anterior open reduction with routine soft tissue releases was performed, and femoral shortening was applied intraoperatively when reduction under excessive tension was observed. Postoperative outcomes were assessed. Results: The mean femoral shortening required was 2.34 ± 0.56 cm (95% CI: 2.18–2.50). Grade IV dislocations required significantly greater shortening (2.51 ± 0.49 cm) than grade III (1.92 ± 0.41 cm, p = 0.001), and children older than 36 months required more shortening (2.63 ± 0.45 cm) compared to younger children (1.98 ± 0.44 cm, p<0.001). Age, side, and IHDI grade IV were independent predictors. Conclusions: In children aged 1–8 years with IHDI III–IV DDH, the mean femoral shortening required for stable, tension-free reduction was 2.34 cm, with older age and higher-grade dislocations predicting greater shortening. Tailored, intraoperative determination of shortening length achieves excellent short-term outcomes with minimal complications, supporting its selective use in pediatric DDH surgery.

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