Closed reduction with traction for developmental dysplasia of the hip in children aged between one and five years

Abstract

The treatment of developmental dysplasia of the hip diagnosed after the first year of life remains controversial. A series of 36 children (47 hips), aged between one and 4.9 years underwent gradual closed reduction using the Petit-Morel method. A pelvic osteotomy was required in 43 hips (91.5%). The patients whose hips did not require pelvic osteotomy were among the youngest. The mean age at final follow-up was 16.1 years (11.3 to 32). The mean follow-up was 14.3 years (10 to 30). At the latest follow-up, 44 hips (93.6%) were graded as excellent or good according to the Severin classification. Closed reduction failed in only two hips (4.3%) which then required open reduction. Mild avascular necrosis was observed in one (2.1%). The accuracy of the reduction and associated low complication rate justify the use of the Petit-Morel technique as the treatment of choice for developmental dysplasia of the hip in patients aged between one and five years.

Have Changes in Treatment of Late-detected Developmental Dysplasia of the Hip During the Last Decades Led to Better Radiographic Outcome?

“…Closed reduction was obtained in more than 90% of the hips and the radiographic outcome at skeletal maturity was satisfactory (Severin Grade I/II) in almost two-thirds. This confirms the experience of other studies with long traction time (4-8 weeks) and gradual reduction [9,15,17] where failure to obtain closed reduction in less than 10% of the hips and low rate of AVN (\ 10%) were reported. Severin Grade I/II at skeletal maturity was obtained in 83% to 96% of the hips both when pelvic osteotomy had been performed at the time of reduction [15] and when pelvic osteotomy was performed later because of residual dysplasia [9,17].…”

Developmental dysplasia of the hip: What has changed in the last 20 years?

“…The reported reduction rates were high, with a low rate of AVN; however, many of these patients had residual acetabular dysplasia and required future acetabular osteotomy as a secondary procedure. These techniques require long traction periods and prolonged hospitalization, which may be difficult both for the children and the family [112][113][114][115][116] .…”

Dysplasia of the hip in children-earlier referrals: a key for better outcomes

“…16 In our unit if a child presents with DDH after 12 weeks, a Pavlik harness is not used as it is unlikely to correct the problem. [4][5][6] In these cases a closed reduction with hip spica application under a general anesthetic is undertaken routinely at five to six months. In our study after one year of age a closed reduction becomes less successful and hence an open reduction is undertaken routinely.…”

“…In our unit, if the child presents at 3 months with DDH then a Pavlik harness is not used as it is unlikely to benefit at this stage. [4][5][6] Instead a closed reduction is undertaken at five to six months of age in these children with good results. 5 A closed reduction is usually undertaken in a child aged 1 year and under.…”