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

Merchant, Rajiv; Singh, Abhinav; Dala-Ali, Benan; Sanghrajka, Anish; Eastwood, Deborah M.

doi:10.1007/s43465-021-00525-z

Cited by 11 publications

(10 citation statements)

References 79 publications

(120 reference statements)

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“…In patients with an early diagnosis within the first 6 months of life, treatment is essentially functional and involves the use of dynamic harnesses and orthoses ( 12 , 13 ). All of them are made to keep the hip in flexion and abduction to reduce the hip and promote hip maturation ( 14 , 15 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of treatment outcomes of stable and unstable developmental dysplasia of the hip with the Tübingen splint

et al. 2022

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BackgroundThe 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.MethodsEpidemiological 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.ResultsWe 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).ConclusionThe 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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Section: Introductionmentioning

confidence: 99%

Comparison of treatment outcomes of stable and unstable developmental dysplasia of the hip with the Tübingen splint

et al. 2022

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“…A variety of braces are available that work on similar principles of limiting hip adduction and extension. The brace eliminates dislocating forces from the hamstrings, the block to reduction of the psoas and improves the muscle line of pull to stabilize the hip joint [4]. The use of excessive force or exceeding the safe zone to maintain hip position can lead to complications, such as femoral nerve palsy and avascular necrosis (AVN) [5][6].…”

Section: Discussionmentioning

confidence: 99%

Inferior Hip Dislocation during Treatment of Developmental Dislocation of Hip – A Rare Complication from Hip Abduction Splint: A Case Report and Review of Literatures

2022

Integr J Orthop Traumatol

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Background: DDH constitutes a group of conditions involving hip sublaxation and dislocation. It is mandatory for management of these cases to be followed by aftercare with Braces. Some complications may develop during follow-up in hip spica or hip brace.Introduction: DDH encompasses a spectrum of diseases that includes dysplasia (a shallow or underdeveloped acetabulum), subluxation, and dislocation. These conditions are commonly seen with arthrogryposis, myelomeningocele, and Larsen's syndrome. Cases of developmental dislocation of the hip (DDH) still occur after walking age because of Late or missed diagnosis and failed conservative treatment. Lack of follow-up leads to a lot of complications.Case presentation: 4years old female child admitted to our hospital complaining of limbing and had neglected history of right DDH. She w managed by derotation femoral osteotomy and hip spica cast with smooth follow-up recovery. At 12 weeks an abduction hip brace was advised but follow-up last for few weeks. When returned back and during routine x-ray inferior dislocation was noticed. Patient planned for surgery and hip Spica cast. Follow-up passed smoothly for 12 months then the Spica cast replaced by Abduction hip brace. The reduction was confirmed by good x-ray.Discussion: Bracing is an important step in follow-up treatment program of DDH. Loss of reduction as a complication may occur during follow-up regimen. Inferior hip dislocation in the hip abduction brace is a rare complication and rarely mentioned in the literatures. Avoidance of this complication can be achieved by having good orthotics in the hospital and applying the brace under supervision of the orthopedic surgeon. Immediate x-ray to check for good position of the head, and closed monitoring of the patient to detect any changes in the hip position. Conclusion:Inferior hip subluxation in the hip brace rarely occurs as a complication during follow-up program of DDH treatment. Early recognition of this complication and reduction of the flexion angle led to a stable dislocation of the hip.

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“…Current literature supports the use of abduction braces in patients under 6 months of age whose dislocations were refractory to Pavlik harness treatment. [1][2][3][4][5] In addition, brace wear was associated with improved acetabular coverage in patients between 6 and 12 months of age with residual dysplasia following Pavlik harness treatment. 6 While it may logically follow that patients who underwent open reduction would experience similar benefits to younger patients treated for residual dysplasia, there is no literature that specifically examines the role of brace treatment following open reduction in reducing acetabular dysplasia or preventing secondary surgery.…”

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confidence: 97%

Abduction Bracing Following Anterior Open Reduction for Developmental Dysplasia of the Hip Does Not Improve Residual Dysplasia or Reduce Secondary Surgery

Kak,

Morris,

Mayfield

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Abduction bracing is commonly used following open reduction and spica casting of developmental dysplasia of the hip. However, there is little evidence to support or refute this practice that carries associated cost and burden for families. The purpose of this study was to determine the efficacy of abduction bracing after open reduction in improving the acetabular dysplasia and reducing the rate of secondary surgery for residual dysplasia. Methods: This is a retrospective study of patients treated with open reduction at a single tertiary referral center. Demographic data, severity of dislocation [International Hip Dysplasia Institute (IHDI) class], age at reduction, and casting duration were obtained. Patients were prescribed no bracing, part-time (≤18 h/d), or full-time (≥20 h/d) brace wear based on surgeon preference. Acetabular index (AI) measurements were obtained at cast removal and at 2- and 4-year follow-up. Results: A total of 146 hips underwent open reduction with 61% (89/146) of hips treated with abduction bracing. There was no difference between braced and nonbraced cohorts with regards to sex, age at time of reduction, dislocation severity, cast duration, immediate postcasting AI, or incidence of medial open reduction. There was no difference in hips treated with or without brace following open reduction with regards to AI at 2 years postreduction (31.8±6.7 vs. 30.4±6.1 degrees, P=0.27) or at 4 years postreduction (24.9±6.5 vs. 24.7±6.5 degrees, P=0.97). However, further analysis showed lower mean AI at 2-year follow-up for braced versus nonbraced patients following medial open reduction (30.0±5.7 vs. 34.5±7.0 degrees, P=0.02). This difference was no longer present at 4-year follow-up (26.6±6.8 vs. 24.2±6.6 degrees, P=0.44). However, 4/19 (21%) nonbraced hips underwent secondary surgery for residual dysplasia and were consequently excluded from the AI measurement at 4 years postreduction (compared with 4/39 [10%] braced hips within the same time period). There was no difference in the rate of secondary surgery between braced and nonbraced hips (30% vs. 33%, respectively, P=0.70). Multivariate analysis demonstrated that neither IHDI classification, bracing, nor age at reduction predicted residual dysplasia. Conclusions: Abduction bracing following anterior open reduction for developmental dysplasia of the hip is not associated with decreased residual dysplasia at 2/4 years postreduction or with decreased secondary surgery. These results suggest that abduction bracing following anterior open reduction may not provide clinical benefit. However, abduction bracing may be beneficial following medial open reduction. A prospective study is necessary to provide more definitive recommendations. Level of Evidence: Level III—therapeutic study.

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

Cited by 11 publications

References 79 publications

Comparison of treatment outcomes of stable and unstable developmental dysplasia of the hip with the Tübingen splint

Comparison of treatment outcomes of stable and unstable developmental dysplasia of the hip with the Tübingen splint

Inferior Hip Dislocation during Treatment of Developmental Dislocation of Hip – A Rare Complication from Hip Abduction Splint: A Case Report and Review of Literatures

Abduction Bracing Following Anterior Open Reduction for Developmental Dysplasia of the Hip Does Not Improve Residual Dysplasia or Reduce Secondary Surgery

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