Adequate growth and development of the hip depends on two main factors: concentric positioning of femoral head into the acetabular cavity and adequate balance in growth between tri-radiate and acetabular cartilage. Any alteration in these two conditions leads to a hip dysplasia & dislocation

Inclusion Criteria:

- Patient with Developmental dysplasia of the hip (DDH) with :

• Age: up to 9 years old.
• Recurrent DDH .
• Failed open reduction through medial approach in the management of DDH.
• Traumatic hip dislocation .

Exclusion Criteria:

• • Paralytic hip dislocation .

  • Post septic hip dislocation.
  • Refusal to participate in this study.

The patients will be examined for:

Length of both lower limbs in relation to each other. Length of both lower limbs according to patient age. Presence of hump related to the outer surface of the hip Presence of pain, abnormal gait, Trendlenburg test Radiographic evaluation (antero posterior and frog pelvis views)

An addition to the steps of the open reduction, the following were done:

1. Trans articular suturing
2. End button tenodesis