Dynamic and Static Splinting for Treatment of Developmental Dysplasia of the Hip: A Systematic Review

Abstract

Background: Developmental dysplasia of the hip (DDH) is one of the most common pediatric conditions. The current gold-standard treatment for children under six months of age with a reducible hip is bracing, but the orthopedic literature features several splint options, and each one has many advantages and disadvantages. The aim of this review is to analyze the available literature to document the up-to-date evidence on DDH conservative treatment. Methods: A systematic review of PubMed and Science Direct databases was performed by two independent authors (C.d.C. and A.V.) using the keywords “developmental dysplasia hip”, “brace”, “harness”, “splint”, “abduction brace” to evaluate studies of any level of evidence that reported clinical or preclinical results and dealt with conservative DDH treatment. The result of every stage was reviewed and approved by the senior investigators (V.P. and G.T.). Results: A total of 1411 articles were found. After the exclusion of duplicates, 367 articles were selected. At the end of the first screening, following the previously described selection criteria, we selected 29 articles eligible for full text reading. The included articles mainly focus on the Pavlik harness, Frejka, and Tubingen among the dynamic splint applications as well as the rhino-style brace, Ilfeld and generic abduction brace among the static splint applications. The main findings of the included articles were summarized. Conclusions: Dynamic splinting for DDH represents a valid therapeutic option in cases of instability and dislocation, especially if applied within 4–5 months of life. Dynamic splinting has a low contraindication. Static bracing is an effective option too, but only for stable hips or residual acetabular dysplasia.

Principles of Bracing in the Early Management of Developmental Dysplasia of the Hip

“…Brace selection is influenced by the size of the infant, severity of dysplasia, physician preference, local availability and affordability. It is difficult to compare braces and define successful outcomes due to heterogeneity in patient selection and lack of consensus on treatment indications [3,13]. The simplest form of bracing is double diapering which has not been shown to be useful maintaining hip reduction [14].…”

“…Static bracing holds the hip in a fixed position using rigid supports. Rigid positioning is advantageous in larger infants close to walking age in whom dynamic bracing is not possible [3]. It is also beneficial in unstable hips that have failed dynamic braces [17][18][19][20].…”

“…Table 1 Fig. 1 Commonly used DDH braces describes the pooled outcomes in terms of success and failure represented in the two systematic reviews [3,13].…”

“…Bracing is considered the gold standard in treating DDH in infants less than 6 months of age with reducible hips [1][2][3]. The infant hip with DDH must be maintained within a safe zone of 100 ° flexion and abduction that does not exceed 60 ° [1].…”

Accuracy of New Deep Learning Model-Based Segmentation and Key-Point Multi-Detection Method for Ultrasonographic Developmental Dysplasia of the Hip (DDH) Screening

“…This spectrum gradually progresses in severity, with treatment becoming more difficult as the patient ages and grows. Fortunately, DDH can be treated simply with a brace or splint when diagnosed early [ 3 , 4 ]. Otherwise, secondary anatomical changes caused by delayed diagnosis could require surgical treatment [ 5 , 6 ].…”