The hip is formed by the acetabulum, the proximal femur and soft tissues joining them (capsule, teres ligament, transverse ligament and pulvinar). The acetabulum is a complex structure in the growing child. It is formed by the joined pubis, This junction is called tri radiate cartilage, which is responsible for acetabular growth. The external surface of the acetabulum is covered by a horse shoe-shaped articular cartilage. The transverse ligament joins both extremes of the articular cartilage inferiorly.

Inclusion Criteria:

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

  • Age: from 9 months -3 years old.
  • Virgin DDH.
  • Failed closed reduction in the management of DDH.
  • Failed open reduction through medial approach in the management of DDH.

Exclusion Criteria:

• • Paralytic hip dislocation .

  • Post septic hip dislocation.
  • Traumatic hip dislocation .
  • Age : below 9 months or above 5 years.
  • 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:

Identification of ligamentum teres and ligamentoplasty