ABSTRACT
PURPOSE: The objective of this study was to evaluate success and complication rates of the Pavlik harness in late-diagnosed hip dislocation (developmental dysplasia of the hip, DDH). We also set out to assess the additional value of an abduction brace for three to six months, when successful reduction using the Pavlik harness was achieved. METHODS: We included 31 patients (31 hips, 28 female, right/left = 4/27) with late-diagnosed hip dislocation treated with a Pavlik harness between 1995 and 2008. The average age at the start treatment was 27 weeks (21-57). None were lost to follow-up; the mean follow-up was 4.2 years (two-10). Of these patients, 61 % were classified as Tönnis type 2, 32 % as type 3 and 7 % as type 4. RESULTS: Of 31 hips, 20 (65 %) were successfully reduced after the use of the Pavlik harness. The average duration of Pavlik treatment was seven weeks (three-12). The mean time to stable reduction was six weeks (three-11), after which the patients were weaned off the Pavlik harness. The mean age at final treatment was 19 months (12-28). Five patients (15.0 %) developed radiological signs of osteonecrosis (Kalamchi and MacEwen classification; two group I, one group II and two group IV). When we compared the different Tönnis types a significant difference in successful reduction was found. Seventeen (81 %) of Tönnis type 2 dislocated hips were successfully reduced, while only two (25 %) of Tönnis type 3-4 hips were (odds ratio 25, p = 0.001). Clinical examination (e.g. limited abduction, positive Ortolani, Barlow or Galeazzi) at the time of diagnosis was not significantly related to the success rate of the Pavlik treatment. The mean acetabular index (AI) significantly improved from 36.5 to 30.5° after initial Pavlik treatment to 22.3° at final follow-up (4.1 years). CONCLUSIONS: Prolonged use of the Pavlik harness in late-diagnosed hip dislocation (DDH) Tönnis type <3 is a safe and successful treatment option in the older infant. Although the AI was significantly reduced after the abduction brace, its additional use remains debatable, as no control group was evaluated.
Subject(s)
Delayed Diagnosis , Hip Dislocation, Congenital/diagnostic imaging , Hip Dislocation, Congenital/therapy , Orthotic Devices , Age Factors , Braces , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Radiography , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
In the treatment of femoral shaft fractures in children, the age, the anatomy of the epiphyseal plates, the vascularisation of the femoral head and the length of hospital stay play an important role. The degree in which a malposition after a femoral shaft fracture is corrected by growth depends on the size, the location and the type of dislocation, and on the residual growth potential of the child. In children up to the age of 4, treatment with traction followed by spica casting almost always gives good results. Children up to age 12 are preferably treated with elastic intramedullary nails, if necessary in combination with a spica cast. In special cases, plate osteosynthesis or external fixation can be used. Children older than 12 years are often too heavy for treatment using elastic nails. Because of the still open growth plate of the greater trochanter, the vascularisation of the femoral head and the diameter of the femur, a standard adult intramedullary nail is not always suitable. Recently, a smaller nail for adolescents was developed, which is currently being tested.
