The following treatment algorithm is based on published literature, Dr. Gourineni's own research, and clinical experience. After closed reduction, assess both instability and internal rotation (FIR), and evaluate acetabular and proximal femoral morphology along with posterior wall fragment size.
1
Good FIR and Stability After Closed Reduction
Fix the posterior wall fragment if:
- The piece is big enough to fix
- It extends to the dome
- Pre-existing posterior wall deficiency exacerbates posterior dysplasia
2
Easily Dislocatable with Good FIR
- Fix even a small piece
- If the piece is not fixable — place a shelf over the capsule
3
Dislocatable with Decreased FIR
- Improve FIR with cam osteoplasty and/or internal rotation osteotomy
- Anterior overcoverage with posterior deficiency — consider anteverting PAO
Principle: Hips can be stabilized well with bony correction. Soft tissue augmentation alone is less desirable and should not be the primary approach when bony correction is achievable.