The document outlines the treatment protocol for developmental dysplasia of the hip (DDH) in neonates and young children, emphasizing the use of Pavlik harnesses and various surgical options depending on the child's age and condition. It details follow-up procedures, closed and open reduction techniques, and various osteotomy options for cases not stable with conservative management. The approach varies significantly from infancy through age six, necessitating a tailored treatment plan based on the child's ongoing assessment.

1. Treatment Overview of DDH

2. • Neonate: Place the child in Pavlik Harness for 6 weeks
• 1-6 Month: Place the child in Pavlik Harness for up to 6 weeks after
the hip reduces

3. • Dynamic splint and holds hip in flexion and abduction
• Indication: Dislocated and reducible hip
• Patient followed up every 1-2 weeks and stability is checked in every
follow-up
• Discontinued 6 weeks after clinical stability

4. • Weaned of up to 2 hours per week till brace is worn only at night
• Transitioning to a night time abduction orthosis for additional weeks
or months
• Four basic patterns of persistent dislocation observed:
Superior, Inferior, Lateral, Posterior
• Superior- Additional Flexion required
• Lateral- Flexion should be reduced
• Inferior- Close observation

5. • 6-18 Month: Treat the child with traction(?) and closed reduction
• Closed reduction : Successful-place the hip in Hip Spica Cast for 3
months

6. Hip Spica Application

7. • Closed reduction : Unsuccessful-open reduction is performed and
placed in hip spica cast immobilisation
• Open reduction : Medial approach in child younger than 12 months
Anterolateral approach in child older than 12 months

8. • 18-24 Months: Treat the patient with the trial of closed reduction or
primary open reduction via anterolateral approach
• Salter or Pemberton Osteotomy may or may not be part of the
procedure
• 24 Months to 6 Years: Primary Open reduction and femoral
shortening with or without Salter or Pemberton osteotomy

10. Salter Osteotomy
• Opening the osteotomy anterolaterally
• By hinging and rotating the acetabular segment on the symphysis
pubis

11. Pemberton Osteotomy
• Osteotomy through full thickness of the ilium
• Triradiate cartilage as hinge, acetabular roof rotated anteriorly and
laterally

12. Dega Osteotomy
• Osteotomy of inferior and middle portion of inner cortex of Ilium
• Intact hinge posteriorly consisting of intact posteromedial iliac cortex
and sciatic notch

13. Chiari Osteotomy
• Hinges on the symphysis pubis
• Distal fragment displacing medially and upward