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If there is exacerbation of pain and reduction in hip motion, hinge abduction should be suspected. Examination under anaesthesia and dynamic arthrography should be done to confirm hinge abduction. If the hip is found to be more congruent in adduction, a proximal femoral valgus osteotomy is indicated. This will overcome impingement of the femoral head on the acetabular margin and also relieve pain . The Bernese group have advocated for using a femoral head reduction procedure via a surgical hip dislocation approach (with or without a concomitant acetabular procedure) for the treatment of hinge abduction secondary to an enlarged femoral head even during the fragmentation phase. Though favorable early outcomes have been reported, long term outcomes have yet to be determined.