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Abstract

Background: Femoral shortening is a critical adjunct during open reduction for developmental dysplasia of the hip (DDH), especially in cases presenting late or with severe dislocation. It reduces soft tissue tension and minimizes complications like avascular necrosis and redislocation. Despite its importance, limited data exist regarding preoperative predictors of its necessity, particularly in local clinical settings.
Objective: To determine the preoperative factors associated with the need for femoral shortening during surgical management of DDH.
Methods: A cross-sectional study was conducted at the Department of Orthopaedic Surgery, Khyber Teaching Hospital, Peshawar. A total of 169 children aged 1–10 years, diagnosed with IHDI grade 3 or 4 DDH and scheduled for open reduction, were enrolled through non-probability consecutive sampling. Data on demographics, clinical history, and radiological findings were collected. The primary outcome was whether femoral shortening was performed, assessed intraoperatively. Statistical analysis was performed using SPSS v25, with chi-square tests and binary logistic regression applied to identify significant predictive factors (p≤0.05).
Results: Femoral shortening was performed in 89 patients (52.7%). Significant predictors included age >5 years (76.4%), female gender (66.2%), breech delivery (64.3%), positive family history of DDH (61.8%), and IHDI grade 4 (72.5%). Each of these variables showed a strong association with the likelihood of undergoing femoral shortening during surgery.
Conclusion: Older age, female gender, breech presentation, familial predisposition, and higher DDH grade are strong preoperative indicators for femoral shortening. Early identification of these factors allows for better surgical planning and improved parental counseling.