Challenges in the management of hip dislocation disease in Madagascar

Table 1 Severin classification

Group	Radiographic appearance	Vertical center edge angle
I	Normal
I-a	Normal	> 19° (ages 6-13)
I-b	Normal	> 25° (older than 13 years)
II	Mild deformity of the femoral head, neck, or acetabulum	Same as group I
III	Dysplasia without subluxation	< 15° (ages 6-13) < 20° (> 13 years)
IV
IV-a	Moderate subluxation	≥ 0°
IV-b	Severe subluxation with neo-hip joint formation at the upper margin of the acetabulum	< 0°
V	Recurrent dislocation

Table 2 Patient characteristics

Variable	Frequency (n = 26)	Proportion (%)
Age at diagnosis (years)
< 1	5	19.23
1-3	12	46.15
> 3	9	34.61
Sex
Female	21	80.75
Male	5	19.25
Reason for consultation
Limping	18	69.23
Delayed walking acquisition	6	23.07
Follow-up radiograph	2	7.69
Tönnis classification
Grade 1	3	19.23
Grade 2	5	34.61
Grade 3	8	30.76
Grade 4	10	38.46
Treatment performed
Closed reduction then hip spica	18	69.23
Closed reduction →adductor tenotomy →hip spica	6	23.07
Closed reduction →salter osteotomy →hip spica	1	3.84
Closed reduction →acetabular shelf procedure →hip spica	1	3.84