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Imerci A, Thacker MM, Bowen JR. Failure of Pavlik Harness Treatment in Infants Under 6 Months Old with Dislocated Hips: Short- and Intermediate-Term Results of Subsequent Treatment Modalities. Indian J Orthop 2024; 58:1288-1296. [PMID: 39170665 PMCID: PMC11333783 DOI: 10.1007/s43465-024-01162-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/16/2024] [Indexed: 08/23/2024]
Abstract
Objective This study aimed to determine the short- and medium-term outcomes of hip dislocation in infants who failed Pavlik harness therapy and were subsequently treated with brace, closed reduction (CR) or open reduction (OR) before 6 months of age. Methods Fifty infants (66 hip dislocations) who failed Pavlik harness therapy between 2000 and 2018 and were treated with a rigid abduction brace or undergoing a CR or OR/cast were evaluated. All demographic data obtained from the medical system, developments and complications during the follow-up and treatment process were recorded and evaluated. Results Fifty infants (66 hips) with dislocated hips failed Pavlik harness therapy. Of these, 9 infants (12 hips) underwent rigid abduction splint therapy: 9 hips were successful, 2 hips had CR and 1 had OR. Thirty-eight infants (51 hips) had index CR, of which 3 (3 hips) failed and had OR. Radiographs of 49 hips (44 patients) were normal at the final evaluation. Pavlik harness therapy starting after 3 weeks (P = 0.028) and unilateral dislocations (P = 0.028) increased the risk of needing operating room. There was an association between OR and avascular necrosis (P = 0.025), but not between OR and other complications-dysplasia and re-dislocation/subluxation (P = 0.257 and P = 0.508, respectively). Conclusion Closed treatment of hip dislocation is possible in most babies who fail Pavlik treatment. Babies who are started on Pavlik therapy after 3 weeks of age may be at increased risk of needing an operating room. Level of Evidence IV.
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Affiliation(s)
- Ahmet Imerci
- Department of Orthopaedic Surgery, Nemours Children’s Health, Delaware, 1600 Rockland Rd., Wilmington, DE 19803 USA
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Mihir M. Thacker
- Department of Orthopaedic Surgery, Nemours Children’s Health, Delaware, 1600 Rockland Rd., Wilmington, DE 19803 USA
| | - James Richard Bowen
- Department of Orthopaedic Surgery, Nemours Children’s Health, Delaware, 1600 Rockland Rd., Wilmington, DE 19803 USA
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Bram JT, Li DT, Tracey OC, Lijesen E, Chipman DE, Widmann RF, Dodwell ER, Blanco JS, Green DW. Hemiepiphysiodesis for Genu Valgum in Patients With Multiple Hereditary Exostoses. J Pediatr Orthop 2024; 44:e406-e410. [PMID: 38450657 DOI: 10.1097/bpo.0000000000002654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Genu valgum is a well-known feature of multiple hereditary exostoses (MHE). Though prior reports have demonstrated successful treatment with hemiepiphysiodesis, details regarding the correction rate and comparison to an idiopathic population are lacking. This study aimed to detail our institution's experience with guided growth of the knee in patients with MHE and compare this to an idiopathic population. METHODS All pediatric patients (age 18 and younger) with MHE who underwent lower extremity hemiepiphysiodesis at a tertiary care medical center between January 2016 and December 2022 were retrospectively reviewed. Preoperative and postoperative mechanical lateral distal femoral angle (mLDFA) and medial proximal tibial angle (MPTA, the primary outcomes) were measured in addition to mechanical axis deviation (MAD) and hip-knee-ankle angle (HKA). Patients were 1:2 matched based on age, sex, and physes instrumented to a cohort with idiopathic genu valgum. RESULTS A total of 21 extremities in 16 patients with MHE underwent hemiepiphysiodesis of the distal femur, proximal tibia, and/or distal tibia. The mean age at surgery was 11.7±2.2 years. Mean MAD corrected from zone 1.9±0.7 to -0.3±1.5, while mLDFA corrected from 83.4±2.9 to 91.7±5.2 degrees and MPTA corrected from 95.3±3.6 to 90.5±4.0 degrees in distal femurs and proximal tibias undergoing guided growth, respectively. Three extremities (14.3%) experienced overcorrection ≥5 degrees managed with observation. There were no differences in correction rates per month for mLDFA (0.54±0.34 vs. 0.51±0.29 degrees, P =0.738) or MPTA (0.31±0.26 vs. 0.50±0.59 degrees, P =0.453) between MHE and idiopathic groups. For 11 extremities in the MHE group with open physes at hardware removal, they experienced a mean recurrence of HKA of 4.0±3.4 degrees at 19-month follow-up. CONCLUSION Hemiepiphysiodesis corrects lower extremity malalignment in patients with MHE at a similar rate compared with an idiopathic coronal plane deformity population. Rebound deformity of 4 degrees at 19 months after hardware removal in patients with remaining open growth plates should make surgeons conscious of the remaining growth potential when planning deformity correction. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Joshua T Bram
- Department of Pediatric Orthopedics, Hospital for Special Surgery, New York, NY
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Li Y, Wang Z, Miao M, Xu Y, Shi J. Residual acetabular dysplasia after Pavlik harness treatment for Graf type II hips. J Child Orthop 2023; 17:306-314. [PMID: 37565002 PMCID: PMC10411375 DOI: 10.1177/18632521231182423] [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: 01/08/2023] [Accepted: 05/29/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose To evaluate the residual acetabular dysplasia in Graf type II hips after Pavlik harness treatment with a radiographic follow-up at 2 years of age. Methods We retrospectively reviewed the developmental dysplasia of the hip patients who were treated with the Pavlik harness between March 2018 and February 2022. Patients with Graf type II hip dysplasia who had at least one radiographic follow-up after 2 years of age were included. The following information, sex, laterality, affected side, age at harness initiation, treatment duration, α angle, and the morphology of bony roof, was collected and studied. We evaluated the radiographic acetabular index at the last follow-up and defined the value of greater than 2 standard deviations as residual acetabular dysplasia. Results A total of 33 patients (53 hips) met the criteria. The mean initial α angle was 53.4°; the mean age at Pavlik harness initiation was 10.9 weeks. The mean treatment duration was 10 weeks. The mean α angle at the last ultrasound follow-up was 64.9°. The mean age of the last radiographic follow-up was 2.6 years, and 26 hips had a residual acetabular dysplasia with acetabular indexes greater than 2 standard deviations above the mean. The morphology of the acetabular bony rim (odds ratio = 4.333, P = 0.029) and age of initial treatment <12 weeks (odds ratio = 7.113, P = 0.014) were seen as significant predictors for a higher acetabular index more than 2 years of age. Conclusions A notable incidence of residual acetabular dysplasia after Pavlik harness treatment in Graf type II hips, wherein the acetabular bony roof with a blunt rim at the end of treatment and initial age after 12 weeks were independent predictors associated with residual acetabular dysplasia. Levels of evidence Therapeutic studies, IV.
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Affiliation(s)
- Yuchan Li
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhigang Wang
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyuan Miao
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunlan Xu
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Shi
- Department of Radiology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ghanem I, Karam G, Ghanem D, Saliba I. Femoral nerve palsy during Pavlik harness treatment for developmental dysplasia of the hip is not an indication for harness abandonment. J Child Orthop 2023; 17:205-211. [PMID: 37288053 PMCID: PMC10242367 DOI: 10.1177/18632521231172986] [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: 12/23/2022] [Accepted: 04/13/2023] [Indexed: 06/09/2023] Open
Abstract
Objectives The aim of this study was to report the incidence of femoral nerve palsy in developmental dysplasia of the hip children treated with Pavlik harness, to identify any possible associated risk factors, and to evaluate its outcome without any specific strap release. Methods A retrospective chart review was conducted on all cases of femoral nerve palsy in a consecutive series of children who underwent Pavlik harness treatment for developmental dysplasia of the hip. In unilateral cases, the developmental dysplasia of the hip was compared to the contralateral side. All hips with femoral nerve palsy were compared to the remaining hips of the series and any possible risk factor for paralysis was recorded. Results In total, 53 cases of femoral nerve palsy of various severity were identified from a group of 473 children with 527 hips treated for developmental dysplasia of the hip at an average age of 3.9 months. However, 93% occurred during the first 2 weeks of treatment. Femoral nerve palsy was more common in older and larger children with the most severe Tonnis type, and a hip flexion angle in the harness above 90° (p < 0.03 for all). All of them resolved spontaneously before completion of treatment without any specific measures. We found no correlation between the presence of femoral nerve palsy or the time taken for spontaneous resolution and treatment failure using the harness. Conclusion Femoral nerve palsy is most observed with higher Tonnis types and high hip flexion angles in the harness, but its presence by itself is not predictive of treatment failure. It resolves spontaneously before completion of treatment and does not require any strap release or harness discontinuation. Level of evidence Level III.
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Affiliation(s)
- Ismat Ghanem
- Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Geoffrey Karam
- Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Diane Ghanem
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ibrahim Saliba
- Department of Orthopedic Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Hareendranathan AR, Wichuk S, Punithakumar K, Dulai S, Jaremko J. Normal variation of infant hip development. Bone Jt Open 2022; 3:913-923. [DOI: 10.1302/2633-1462.311.bjo-2022-0081.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aims Studies of infant hip development to date have been limited by considering only the changes in appearance of a single ultrasound slice (Graf’s standard plane). We used 3D ultrasound (3DUS) to establish maturation curves of normal infant hip development, quantifying variation by age, sex, side, and anteroposterior location in the hip. Methods We analyzed 3DUS scans of 519 infants (mean age 64 days (6 to 111 days)) presenting at a tertiary children’s hospital for suspicion of developmental dysplasia of the hip (DDH). Hips that did not require ultrasound follow-up or treatment were classified as ‘typically developing’. We calculated traditional DDH indices like α angle (αSP), femoral head coverage (FHCSP), and several novel indices from 3DUS like the acetabular contact angle (ACA) and osculating circle radius (OCR) using custom software. Results α angle, FHC, and ACA indices increased and OCR decreased significantly by age in the first four months, mean αSP rose from 62.2° (SD 5.7°) to 67.3° (SD 5.2°) (p < 0.001) in one- to eight- and nine- to 16-week-old infants, respectively. Mean αSP and mean FHCSP were significantly, but only slightly, lower in females than in males. There was no statistically significant difference in DDH indices observed between left and right hip. All 3DUS indices varied significantly between anterior and posterior section of the hip. Mean 3D indices of α angle and FHC were significantly lower anteriorly than posteriorly: αAnt = 58.2° (SD 6.1°), αPost = 63.8° (SD 6.3°) (p < 0.001), FHCAnt = 43.0 (SD 7.4), and FHCPost = 55.4° (SD 11.2°) (p < 0.001). Acetabular rounding measured byOCR indices was significantly greater in the anterior section of the hip (p < 0.001). Conclusion We used 3DUS to show that hip shape and normal growth pattern vary significantly between anterior and posterior regions, by magnitudes similar to age-related changes. This highlights the need for careful selection of the Graf plane during 2D ultrasound examination. Whole-joint evaluation by obtaining either 3DUS or manual ‘sweep’ video images provides more comprehensive DDH assessment. Cite this article: Bone Jt Open 2022;3(11):913–923.
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Salton RL, Carry P, Freeman T, Holmes K, Miller NH, Kohuth B, Burke D, Belton M, Murphy-Zane MS, Georgopoulos G. Twelve-week standard of care protocol longer than median time to normalization among IIc hips treated with Pavlik harness. J Pediatr Orthop B 2022; 31:313-318. [PMID: 35102060 DOI: 10.1097/bpb.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Best treatment protocols for infants with developmental dysplasia of the hip (DDH) are poorly defined. This study estimates the time to normalization among Graf IIc hips undergoing Pavlik harness treatment. Following institutional review board approval, patients referred for DDH evaluation at a pediatric institution between 2009 and 2018 (n = 1424 hips/712 patients) were identified. We isolated all Graf IIc hips that underwent Pavlik harness treatment (n = 132 hips/n = 106 patients). Demographic and outcome measures were collected. Normalization was defined as alpha angle greater than or equal to 60° and femoral head coverage greater than or equal to 50%. Kaplan-Meier and Cox proportional hazards regression analyses modeled time to normalization and identified factors associated with earlier normalization. Median time to normalization was 7.0 weeks. At 12 weeks standard treatment, 85.8% [95% confidence interval (CI): 80.2-91.9%] had normalized. Greater femoral head coverage [hazard ratio (HR) per 1% increase: 1.03; 95% CI: 1.01-1.05; P = 0.0068] and hip stability at treatment initiation (HR unstable vs. stable: 0.64; 95% CI: 0.44-0.93; P = 0.0192) were associated with longer time to normalization. Some patients may not need 12 weeks of Pavlik bracing, particularly those with stable presentation who normalize before week 12. Shorter treatment lengths offer benefit without sacrificing long-term outcomes. Findings reinforce growing evidence that femoral head coverage should be a more significant consideration during diagnosis and instability is a concerning finding on examination.
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Affiliation(s)
- Reba L Salton
- Musculoskeletal Research Center, Orthopedics Institute, Children's Hospital Colorado
| | - Patrick Carry
- Musculoskeletal Research Center, Orthopedics Institute, Children's Hospital Colorado
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
| | - Tyler Freeman
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
| | - Kaley Holmes
- Musculoskeletal Research Center, Orthopedics Institute, Children's Hospital Colorado
| | - Nancy H Miller
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Brian Kohuth
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Deborah Burke
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Matthew Belton
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
| | - Margaret Siobhan Murphy-Zane
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Gaia Georgopoulos
- Department of Orthopedics, Anschutz Medical Campus, University of Colorado School of Medicine
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
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Mousavibaygei SR, Karimnia A, Gerami MH, Azadmehr F, Erfanifam T, Ghaedi A. An evaluation of clinical and ultrasound results of Pavlik harness treatment for developmental dysplasia of the hip. J Med Life 2022; 15:850-853. [PMID: 35928353 PMCID: PMC9321489 DOI: 10.25122/jml-2021-0289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/06/2022] [Indexed: 11/21/2022] Open
Abstract
Developmental dysplasia of the hip (DDH) is the instability or dislocation of the hip joint at birth that may occur in utero, during infancy, and childhood. This condition was identified as an important challenge. This study aimed to determine the clinical and ultrasound results of Pavlik harness treatment for DDH in patients referred to the pediatric clinic of Imam Khomeini Hospital in Ahvaz. This is a descriptive cross-sectional study in which 100 newborns aged 15 to 30 days were included by the census method after obtaining parental consent. Follow-up of the infants was performed at 3 and 6 months after treatment. All analyzes were performed using SPSS version 22 at a significance level of 0.05. The results showed that the mean age of the infants was 23.46±2.12 days, of which 33 infants were boys and 67 girls. The involvement on the right and left sides was 39% and 50%, respectively, and 11% of the infants had bilateral involvement. The mean value of acetabular index before placement was 25.48±6.509 and 26.38±3.866 on the right and left sides, which after 3 months of placement, was reduced to 21.62±2.578 and 21.57±2.839, respectively. Pavlik harness treatment was associated with acceptable radiological results in infants. This technique seems to be a suitable and applicable attempt to treat this problem and prevent serious and irreversible complications of late diagnosis.
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Affiliation(s)
| | - Amir Karimnia
- Department of Orthopedic Surgery, Imam Reza Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohamad Hadi Gerami
- Department of Orthopaedics, Bone and Joint Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Azadmehr
- Department of Medical Surgical Nursing, Boukan Nursing Faculty, Urmia University of Medical Sciences, Urmia, Iran
| | - Taher Erfanifam
- Department of Surgery, Iran University of Medical Science, Tehran, Iran
| | - Amin Ghaedi
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,Corresponding Author: Amin Ghaedi, Department of Orthopaedics and Traumatology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. E-mail:
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Badrinath R, Orner C, Bomar JD, Upasani VV. Narrative Review of Complications Following DDH Treatment. Indian J Orthop 2021; 55:1490-1502. [PMID: 34987725 PMCID: PMC8688677 DOI: 10.1007/s43465-021-00550-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/10/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this narrative review was to survey the literature for common complications following treatment of DDH in children less than 4 years old. METHODS The Pubmed database was queried. Search result titles were reviewed to identify papers that were pertinent to the topic. Abstracts for these papers were obtained and read, and a subset of these were selected for review of the complete manuscript. RESULTS 92 manuscripts were reviewed. Residual dysplasia, redislocation, and osteonecrosis are the primary complications of treatment in this age group. In the long term, hips without complications related to DDH treatment tend to do well, although a significant percentage of them will inevitably require joint replacement surgery. CONCLUSION Although there is excellent potential for a good outcome when DDH is diagnosed and treated under age 4 years, osteonecrosis continues to be a concern with all treatment methods. A subset of patients from this young cohort will continue to have residual dysplasia or recurrent dislocation requiring return to the operating room.
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Affiliation(s)
- Raghav Badrinath
- Orthopedics and Scoliosis, Rady Children’s Hospital San Diego, 3020 Children’s Way, MC 5062, San Diego, CA 92123 USA
| | - Caitlin Orner
- Orthopedics and Scoliosis, Rady Children’s Hospital San Diego, 3020 Children’s Way, MC 5062, San Diego, CA 92123 USA
| | - James D. Bomar
- Orthopedics and Scoliosis, Rady Children’s Hospital San Diego, 3020 Children’s Way, MC 5062, San Diego, CA 92123 USA
| | - Vidyadhar V. Upasani
- Orthopedics and Scoliosis, Rady Children’s Hospital San Diego, 3020 Children’s Way, MC 5062, San Diego, CA 92123 USA
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Young JR, Anderson MJ, O'Connor CM, Kazley JM, Mantica AL, Dutt V. Team Approach: Developmental Dysplasia of the Hip. JBJS Rev 2021; 8:e20.00030. [PMID: 32890048 DOI: 10.2106/jbjs.rvw.20.00030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Developmental dysplasia of the hip (DDH) encompasses a wide spectrum of hip disorders, including neonatal instability, acetabular dysplasia, hip subluxation, and frank dislocation of the hip. It is a common disorder, with a reported incidence of between 0.1% and >10% of live births.
Coordinated, interdisciplinary care is important to achieving successful outcomes. This starts with accurate assessment of risk factors in the prenatal period, thorough clinical examination by the primary care provider at all well-child visits, and early referral to a pediatric orthopaedic surgeon for prompt diagnosis and treatment. Early diagnosis and prompt treatment is critical for an excellent outcome. Ongoing, open communication between clinicians is essential for the effective coordination of care. Treatment options vary depending on the age of presentation. A Pavlik harness (dynamic hip abduction orthosis) is used for children up to 6 months of age. A more rigid abduction orthosis may be used if treatment with a Pavlik harness is unsuccessful, with a closed reduction and spica cast being the next step if needed for children up to 18 months of age. Finally, open reduction with possible concomitant femoral and/or pelvic osteotomies is the surgical option in an older child, when necessary. In general, the later the child is diagnosed with and treated for DDH, the greater the risk of a nonoptimal outcome. Depending on the severity of the condition, children with DDH may need to be followed closely until skeletal maturity so as not to miss the diagnosis of asymptomatic residual hip dysplasia, which can predispose patients to early hip arthritis.
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Affiliation(s)
- Joseph R Young
- Division of Orthopedic Surgery, Albany Medical Center, Albany, New York
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Clinical study of anterior hip ultrasound (van Douveren's method)-assisted Pavlik harness. INTERNATIONAL ORTHOPAEDICS 2018; 43:1135-1141. [PMID: 30116866 DOI: 10.1007/s00264-018-4103-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 08/08/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE To investigate the use of anterior hip ultrasound (van Douveren's method)-assisted Pavlik harness in developmental dysplasia of the hip (DDH). METHODS Weekly anterior hip ultrasound scanning was performed in children with fixed Pavlik harness to detect whether hip reduction was achieved with the help of harness (the superior ramus of the pubis, the acetabulum, the femoral head, and the femoral neck being depicted in one plane indicated concentric reduction of the hip), and the stability of the reduction was checked by ultrasonography. RESULTS A total of 39 child patients and 51 dysplastic hips were successfully detected by anterior ultrasound, and stable reduction was achieved in 37 hips (15 Graf type D and 22 type III) right after the help of Pavlik harness, in seven hips (6 type III and 1 type IV) two weeks after the help of Pavlik harness; the remaining seven hips (2 type III and 5 type IV) failed to reach stable reduction after two weeks. CONCLUSION The anterior hip ultrasound (van Douveren's method) can be used to detect the reduction and stability of hip after Pavlik harness treatment in children with DDH. The majority of Graf type D and III hips can achieve a stable concentric reduction right after the help of Pavlik harness, while severely dislocated type IV hips have a low success rate for harness treatment, and abandonment of harness therapy should be considered in early stage.
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