The Effect of Traction before Closed Reduction in Patients with Developmental Dysplasia of the Hip

Abstract

Developmental dysplasia of the hip (DDH) with a dislocated hip can be treated with traction before closed reduction (CR). Currently, there is insufficient evidence supporting the use of preoperative traction treatment for a successful CR. The objective of this study was to determine the effect of preoperative traction on the success rate of primary CR in DDH patients with dislocated hips. A retrospective pair-matched study was performed in DDH patients with dislocated hips. Patients with preoperative traction treatment prior to primary CR were matched (based on age and the severity of DDH on the radiograph) to patients without preoperative traction treatment. The primary outcome was the presence or absence of maintained reduction after three weeks. A match was found for 37 hips, which resulted in the inclusion of 74 hips. No significant difference was found in the number of successful reductions after three weeks between the traction group and the control group (31 vs. 33 hips, p = 0.496). Traction treatment did not significantly improve the short-term or mid-term outcomes for closed reduction. Based on these results, we suggest that traction treatment should not be used as standard care for dislocated hips in DDH.

Preoperative Gallows traction as an adjunct to hip open reduction surgery: Is it safe and is it effective?

“…It can be difficult to tease out any protective effect of individual factors, which undoubtedly reflects conflicting views in the literature. [7][8][9][10][11][12][13][14][15] Previous studies have advocated the effectiveness of traction at preventing complications following closed reduction, particularly AVN. [7][8][9] However, recent literature suggests traction does not affect the stability of reduction nor protect against AVN of the femoral head following closed reduction.…”

“…[7][8][9] However, recent literature suggests traction does not affect the stability of reduction nor protect against AVN of the femoral head following closed reduction. [13][14][15] The unproven protective effect of traction, combined with the added burden on nursing, resources, and family units, has resulted in a growing consensus that traction has limited clinical utility. [10][11][12][13][14][15] At a mean of 6-year follow-up in this study, 96% of this cohort were Severin 1 or 2 (excellent or good radiological appearance) on final follow-up.…”

“…[13][14][15] The unproven protective effect of traction, combined with the added burden on nursing, resources, and family units, has resulted in a growing consensus that traction has limited clinical utility. [10][11][12][13][14][15] At a mean of 6-year follow-up in this study, 96% of this cohort were Severin 1 or 2 (excellent or good radiological appearance) on final follow-up. The Severin classification assesses both deformity of the femoral head and acetabulum and evaluates the position of the femoral head in relation to the acetabulum, in doing so allowing accurate interpretation of the proximal femoral growth disturbance in this cohort of hips.…”

“…In addition, the existing literature on Gallows traction regarding the protective effect of pre-reduction traction on AVN mainly focuses on it use before closed reduction. [7][8][9][10][11][12][13][14][15] To date, there does not appear to be existing literature on Gallows traction related to whether traction over the course of 1 week is effective in reducing the soft-tissue tension or decreases the height of hip dislocation before surgery, which ultimately is the theorized benefit of traction. [7][8][9][10][11][12][13][14][15] The use of traction is associated with subsequent complications, with complications of traction reported in the literature from the 1950s.…”

“…[7][8][9][10][11][12][13][14][15] To date, there does not appear to be existing literature on Gallows traction related to whether traction over the course of 1 week is effective in reducing the soft-tissue tension or decreases the height of hip dislocation before surgery, which ultimately is the theorized benefit of traction. [7][8][9][10][11][12][13][14][15] The use of traction is associated with subsequent complications, with complications of traction reported in the literature from the 1950s. These included significant neurovascular compromise and skin problems.…”