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Nair A, Yatsonsky D, Liu J. Comparison of outcomes of different Graf grades of developmental dysplasia of the hip in infants treated with Tubingen splint versus Pavlik harness - A systematic review. J Orthop 2024; 49:68-74. [PMID: 38075458 PMCID: PMC10701362 DOI: 10.1016/j.jor.2023.11.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 02/29/2024] Open
Abstract
This systematic review was designed to compare the outcomes of the two braces against each other classified by the Graf method. The databases sources included PubMed, Embase, and Google Scholar. The keywords included "DDH Tubingen versus Pavlik" and Tubingen and Pavlik separately. Included papers provided specific data regarding success and failure rate, avascular necrosis (AVN), duration, and age of intervention. The excluded studies discussed surgeries, diagnosis and mechanism, and ones that weren't in English. Total of 20 papers were included, resulting in 1243 Tubingen and 420 Pavlik samples. It was seen that the Tubingen splint had a statistically significant greater success rate and lower failure rate for Graf 2, D, and 3 hips, while both braces were not very successful for Graf 4 at success rates less than 60 %. Tubingen also had a lower incidence of AVN. Both braces shared similar ages of intervention, duration, and time per day. Both braces are very comparable to each other, each having better success rates for lower Graf grades, which points to the importance of bracing earlier to improve the success rates. The Tubingen splint had a higher success rate, lower failure rate, and lower AVN rate compared to the Pavlik harness. This points to the Tubingen splint potentially being the preferred option for bracing in infants.
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Affiliation(s)
- Ajay Nair
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, 43614, United States
| | - David Yatsonsky
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, 43614, United States
| | - Jiayong Liu
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, 43614, United States
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Chaibi E, Saugy CA, Samara E, Zambelli PY, Merckaert SR. Comparison of treatment outcomes of stable and unstable developmental dysplasia of the hip with the Tübingen splint. Front Pediatr 2022; 10:976367. [PMID: 36090577 PMCID: PMC9453388 DOI: 10.3389/fped.2022.976367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Tübingen splint was initially developed for the treatment of stable developmental hip dysplasia (DDH). Later on, some authors expanded its include for the treatment of unstable DDH, but there remain some controversies in the literature. This study aims to compare the outcome between stable and unstable DDH treated with a Tübingen splint. METHODS Epidemiological data and ultrasonographic data of all infants diagnosed with DDH and initially treated with a Tübingen splint at our institution between May 2017 and February 2020 were assessed retrospectively. We divided the population into stable and unstable hips using the Graf classification. Age at treatment initiation, duration of treatment, complications, and radiological outcome between 12 and 24 months were investigated. RESULTS We included a total of 45 patients (57 hips) affected by DDH treated with the Tübingen splint. Treatment has been successful in 93% of stable hips and only 40% of unstable hips. Radiological outcome at 1-year follow-up significantly correlated with initial Graf classification (p < 0.001). CONCLUSION The Tübingen splint is a safe and effective treatment for stable hips, nevertheless, for unstable hips, closed reduction, and spica cast remains the gold standard.
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Affiliation(s)
- Emmelie Chaibi
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Claire-Anne Saugy
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Eleftheria Samara
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pierre-Yves Zambelli
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sophie Rosa Merckaert
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Zhi X, Xiao X, Wan Y, Wei P, Canavese F, Xu H. Tübingen hip flexion splint for the treatment of developmental dysplasia of the hip in children younger than six months age: a meta-analysis. J Child Orthop 2021; 15:402-408. [PMID: 34476031 PMCID: PMC8381402 DOI: 10.1302/1863-2548.15.210015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/17/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate the success rate of the Tübingen hip flexion splint (THFS) for the treatment of developmental dysplasia of the hip (DDH), of different severity as per the Graf classification, among infants younger than six months of age. The type and incidence rate of complications associated with THFS treatment were also evaluated. METHODS The following databases were searched using keywords and limited for age less than six months: PubMed, Embase, Web of Science, Cochrane Library, and SinoMed, between inception and July 2020. Articles were screened and extracted by two researchers, and the quality of the included literature was evaluated (methodological index for non-randomized studies criteria). R studio 1.3 was used for statistical analysis. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS After screening, eight articles were included in the analysis, contributing 1211 hips (875 patients). The overall success rate of THFS treatment is 91% (95% confidence interval (CI) 0.82 to 0.95). The success rate by Graf type is as follows: type-II, 98% (95% CI 0.94 to 1.00); type-III, 96% (95% CI 0.88 to 1.00); and type-IV, 32% (95% CI 0.18 to 0.47). Complications (24/1211, 2%) included transient femoral nerve palsy (n = 1); avascular necrosis of the femoral head (n = 9) and residual acetabular dysplasia (n = 14). CONCLUSION THFS treatment is successful for Graf type-II and -III, but low for type-IV, with a low rate of complication. THFS may be an effective treatment option for DDH among infants less than six months of age. However, those with Graf type-IV require close monitoring. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Xinwang Zhi
- Department of Pediatric Orthopedics, Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Xietian Xiao
- School of Public Health, Guangzhou Medical University, Xinzao, Guangzhou, China
| | - Yuwei Wan
- School of Public Health, Guangzhou Medical University, Xinzao, Guangzhou, China
| | - Ping Wei
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou, China
| | - Federico Canavese
- Department of Pediatric Orthopedics, Guangzhou Women and Children’s Medical Center, Guangzhou, China,Department of Pediatric Orthopedic Surgery, Lille University Center and Faculty of Medicine, Lille, France,These authors contributed equally to this work
| | - Hongwen Xu
- Department of Pediatric Orthopedics, Guangzhou Women and Children’s Medical Center, Guangzhou, China,These authors contributed equally to this work,Correspondence Correspondence should be sent to Dr Hongwen Xu, Department of Pediatric Orthopedics, Guangzhou Women and Children’s Medical Center, Guangzhou, 510623 China E-mail:
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Ashoor M, Abdulla N, Elgabaly EA, Aldlyami E, Alshryda S. Evidence based treatment for developmental dysplasia of the hip in children under 6 months of age. Systematic review and exploratory analysis. Surgeon 2021; 19:77-86. [PMID: 32249037 DOI: 10.1016/j.surge.2020.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/04/2020] [Accepted: 02/24/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Developmental dysplasia of the hip (DDH) is a common paediatric orthopaedic condition that attracts a substantive amount of controversy. The treatments vary because of the wide spectrum of the condition and the age of children at presentation. Although conservative and surgical treatments exist; it is widely accepted that conservative treatment is the first line of treatment in the first 6 months of life. Several devices have been proposed as the treatment of choice; however, to the best of our knowledge these have not been critically appraised. Therefore, we conducted this review. METHODS A modified Cochrane method was followed with a preplanned detailed research protocol that was developed to guide all aspects of the review. Treatment failure of the devices was chosen as the primary outcome. Secondary outcomes included femoral nerve palsy (FNP), avascular necrosis of the femoral head (AVN), residual dysplasia, skin problems, failure of subsequent surgical treatment, compliance and tolerance issues. Results are reported according to the PRISMA guidelines. RESULTS A total of 30 studies were included in the review comparing 5 devices (The Pavlik harness, the Von Rosen splint, the Tubingen brace, the Frejka pillow, and the Aberdeen splint). The devices were compared in terms of success rate, AVN rate and residual dysplasia. The von Rosen splint has been shown to be superior to other devices in term of success rates and residual dysplasia (Χ2: P < 0.05). CONCLUSION The review findings should be interpreted with caution as there are substantive flaws in the literature and a randomized control trail is warranted to confirm the best device to treat DDH. This is feasible given the magnitude of the problem, the clear diagnostic criteria and the treatment options.
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Affiliation(s)
- Maryam Ashoor
- Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates.
| | - Nada Abdulla
- Medical School, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates
| | | | - Ehab Aldlyami
- Medicare Orthopaedics and Spine Hospital, Dubai, United Arab Emirates
| | - Sattar Alshryda
- Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
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Zhou Y, Li R, Li C, Zhou P, Li Y, Ke YH, Jiang F, Kang XP. Tübingen hip flexion splints for developmental dysplasia of the hip in infants aged 0-6 months. BMC Pediatr 2020; 20:280. [PMID: 32503452 PMCID: PMC7275443 DOI: 10.1186/s12887-020-02171-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 05/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background Developmental dysplasia of the hip (DDH) is a common disorder in infants. The present study aimed to evaluate the efficacy and safety of the Tübingen hip flexion splints in treating DDH in infants aged 0–6 months. Methods This is a retrospective study analyzing 259 hips in 195 infants with DDH of Graf type IIc or worse classifications treated between January 2015 and December 2017. Patients were followed up for at least 6 months. Avascular necrosis of the femoral head was diagnosed using plain radiographs at the last follow-up visit according to the Bucholz-Ogden classification. Successful treatment was defined as an improvement of the Graft classification to type I, or an improvement of the International Hip Dysplasia Institute classification to type I in patients aged > 6 months. Results Treatment was deemed successful in 128 patients (83.7%). Avascular necrosis occurred in 3 patients (3 hips). Univariate analysis showed that late treatment initiation, family history of DDH, Graf type IV and bilateral involvement were independent risk factors for treatment failure (p < 0.05). The receiver operating characteristic curve showed a cut-off value of 12 weeks for age at treatment initiation regarding successful treatment. Logistic regression analysis showed that gender, breech presentation, firstborn, swaddling, birth weight > 3.5 kg, oligohydramnios, foot deformity and torticollis did not affect the success rate of treatment (p > 0.05). Conclusions The Tübingen splint showed good efficacy and safety in treating DDH in infants aged 0–6 months. Family history of DDH, Graf classification of type IV, bilateral involvement and treatment initiation after 12 weeks of age are risk factors of treatment failure. Trial registration N/A
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Affiliation(s)
- You Zhou
- Department of Orthopedics, Kunming Children's Hospital, 288 Qianxing Road, Xishan District, Kunming, 650034, Yunnan, China
| | - Rong Li
- Department of Obstetrics, First Affiliated Hospital of Kunming Medical University, Kunming, 650000, China
| | - Chuan Li
- Department of Orthopedics, People's Liberation Army Joint Logistic Support Force 920th Hospital, Kunming, 650032, China
| | - Ping Zhou
- Department of Orthopedics, Kunming Children's Hospital, 288 Qianxing Road, Xishan District, Kunming, 650034, Yunnan, China
| | - Yan Li
- Department of Orthopedics, Kunming Children's Hospital, 288 Qianxing Road, Xishan District, Kunming, 650034, Yunnan, China
| | - You-Hao Ke
- Department of Orthopedics, Kunming Children's Hospital, 288 Qianxing Road, Xishan District, Kunming, 650034, Yunnan, China
| | - Fei Jiang
- Department of Orthopedics, Kunming Children's Hospital, 288 Qianxing Road, Xishan District, Kunming, 650034, Yunnan, China
| | - Xiao-Peng Kang
- Department of Orthopedics, Kunming Children's Hospital, 288 Qianxing Road, Xishan District, Kunming, 650034, Yunnan, China.
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