Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age

Dwan, Kerry; Kirkham, Jamie; Paton, R. W.; Morley, Emma; Newton, Ashley W.; Perry, Daniel C.

doi:10.1002/14651858.cd012717

Cited by 6 publications

(9 citation statements)

References 23 publications

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“…Few studies have reported the efficacy of different splints: some compared the use of the Frejka pillow with the Von Rosen splint, and others described the Craig and the Von Rosen splints to be slightly superior to the Pavlik harness [27,38,39]. Surely, the Pavlik harness remains the most preferred treatment for the majority of children younger than 6 months, as it is the most thoroughly described and analyzed and found to be safe and highly effective with large samples [10,23]. The most satisfying outcomes were described with the use of Tubingen (97.5%), Von Rosen (100%), Aberdeen (98.3%%), Coxaflex (98.3%%) and Teufel (100%) splints, but the small sample of the latter three braces does not aid comparison.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

“…The Pavlik harness is the most popular dynamic splint. Other dynamic splints used for treating DDH are the Tubingen splint, Frejka pillow, Von Rosen splint, Aberdeen splint, Coxaflex and Teufel brace [6][7][8][9][10][11][12]. The static splints promote a "rigid reduction".…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…Developmental dysplasia of the hip (DDH) is an abnormal development of the femoral head resulting in subluxation or dislocation of the hip in about 0.1–1% of the newborn population ( Barlow, 1962 ; Gross et al, 1982 ; Tredwell, 1992 ; Storer and Skaggs, 2006 ). Early treatment of DDH using pelvic osteotomy has been shown to be effective in restoring hip morphology and reducing disease progression and complications such as leg length discrepancy ( Michaeli et al, 1997 ; Nahit et al, 1998 ; Dwan et al, 2017 ; Sucato et al, 2017 ; Chen et al, 2018 ). However, residual deficits such as muscle weakness and changes of the lower limb joint mechanics remain ( Storer and Skaggs, 2006 ), affecting the body’s balance control and dynamic stability with increased risk of falls leading to musculoskeletal injuries ( Bassett GS.…”

Section: Introductionmentioning

confidence: 99%

“…et al, 1999 ; Sturnieks et al, 2004 ; Pedersen et al, 2006 ; El-Sayed, 2009 ). Further, about 25–73% of children with treated DDH develop different types of avascular necrosis (AVN) of the femoral head ( Kalamchi and MacEwen, 1980 ; Wu et al, 2012 ; Tang et al, 2015 ; Dwan et al, 2017 ; Sucato et al, 2017 ; Sankar et al, 2019 ). AVN secondary to treated DDH not only affects the development and biomechanics of the hip ( Cooperman et al, 1983 ), but also predisposes the patients to premature osteoarthritis ( McKay, 1974 ; Roach et al, 1997 ; Wang et al, 2016 ) with increased risk of falls ( Lin et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Avascular Necrosis of the Hip Compromises Gait Balance Control in Female Juveniles With Unilateral Developmental Dysplasia Treated in Toddlerhood

Lee

Chen

et al. 2022

Front. Bioeng. Biotechnol.

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Avascular necrosis of the hip (AVN) is one of the most severe complications of surgical reduction when treating developmental dysplasia of the hip (DDH). The current study identified the differences in the balance control during walking in terms of the inclination angle (IA) of the center of pressure (COP) to the center of mass (COM), and the rate of change of IA (RCIA) between female juveniles with and without secondary AVN at the hip who were treated for unilateral DDH during toddlerhood as compared to their healthy peers. When compared to female healthy controls, the non-AVN group showed bilaterally similar compromised balance control with significantly decreased IA (p < 0.05) but increased RCIA (p < 0.04) in the sagittal plane during single-limb support (SLS) of the unaffected side, and in the frontal plane during terminal double-limb support (DLS) of the affected side. In contrast, the AVN increased between-side differences in the sagittal IA (p = 0.01), and sagittal and frontal RCIA during DLS (p < 0.04), leading to bilaterally asymmetrical balance control. Secondary AVN significantly reduced IA and RCIA in the sagittal plane (p < 0.05), and reduced range of RCIA in the frontal plane during initial DLS (p < 0.05). The trend reversed during terminal DLS, indicating a conservative COM-COP control in the sagittal plane and a compromised control in the frontal plane during body weight acceptance, with a compromised COM-COP control in the frontal plane during weight release. The current results suggest that increased between-side differences in the sagittal IA, and sagittal and frontal RCIA during DLS are a sign of AVN secondary to treated unilateral DDH in female juveniles, and should be monitored regularly for early identification of the disease.

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“…In order to make a diagnosis, ultrasound scans (USS) are used to confirm clinical suspicion, after which abduction splinting is used in the first instance for management [4,5]. The Pavlik harness is the most widely used, with high success rates [4], though other fixed and dynamic splints are utilised [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Repeated Pelvic Radiographs in Infants, After Harness Treatment for Developmental Dysplasia of the Hip, Carry Very Low Radiation Risk

Vogel

Leaver

Wall

et al. 2021

JOIO

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Objective There are no data on the effect of X-Ray irradiation to the vulnerable pelvic organs of babies during DDH follow-up. This study aims to calculate, for the first time, the radiation exposure to infants during follow-up for DDH harness treatment, and thus quantify the lifetime risk of malignancy. Methods Patients who had completed 5 years’ follow-up following successful Pavlik harness treatment were identified from the hospital DDH database. The radiation dose was extracted from the Computerised Radiology Information System database for every radiograph of every patient. The effective dose (ED) was calculated using conversion coefficients for age, sex and body region irradiated. Cumulative ED was compared to Health Protection Agency standards to calculate lifetime risk of malignancy from the radiographs. Results All radiographs of 40 infants, successfully treated in Pavlik harness for DDH, were assessed. The mean number of AP pelvis radiographs was 7.00 (range: 6–9, mode: 7). The mean cumulative ED was 0.25 mSv (Range: 0.11–0.46, SD: 0.07). This is far lower than the annual ‘safe’ limit for healthcare workers of 20 mSv and is categorised as “Very Low Risk”. Conclusion Clinicians involved in the treatment DDH can be re-assured that the cumulative radiation exposure from pelvic radiographs following Pavlik harness treatment is “Very Low Risk”. Whilst being mindful of any radiation exposure in children, this study provides a scientific answer that help addresses parental concerns.

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Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age

Abstract: Splinting for the non-operative management of developmental dysplasia of the hip (DDH) in children under six months of age.

Cited by 6 publications

References 23 publications

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

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

Avascular Necrosis of the Hip Compromises Gait Balance Control in Female Juveniles With Unilateral Developmental Dysplasia Treated in Toddlerhood

Repeated Pelvic Radiographs in Infants, After Harness Treatment for Developmental Dysplasia of the Hip, Carry Very Low Radiation Risk

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