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Does early treatment by abduction splintage improve the development of dysplastic but stable neonatal hips?
M K Wood1, V Conboy, M K Benson
1The Nuffield Orthopaedic Centre, Headington, Oxford, United Kingdom.
Insights
Stable hip dysplasia in infants may correct naturally with growth. Early splint treatment showed initial improvement in acetabular cover but no sustained benefit over observation by 24 months.
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Background:
- Developmental Dysplasia of the Hip (DDH) is a common condition in infants.
- Early detection and treatment are crucial for optimal outcomes.
Purpose of the Study:
- To compare the effectiveness of abduction splintage versus observation for stable but dysplastic hips in infants.
- To evaluate long-term outcomes and the sustained benefit of early intervention.
Main Methods:
- A prospective randomized trial involving 44 infants (63 hips) aged 2 to 6 weeks with stable dysplastic hips.
- Hips were randomly assigned to either abduction splintage or observation.
- Ultrasound and plain radiographs were used to measure acetabular cover and acetabular angles at baseline, 3 months, and 24 months.
Main Results:
- The splinted group showed a significantly greater improvement in ultrasound-measured acetabular cover at 3 months compared to the observation group (54.3% vs. 48.6%).
- However, no significant differences in acetabular angles were observed between the groups on radiographs at 3 months or 24 months.
- These findings suggest that initial gains from splintage do not translate to long-term structural correction.
Conclusions:
- Stable dysplastic hips in infants tend to correct spontaneously with growth.
- There is no demonstrable sustained benefit from early abduction splintage for stable hip dysplasia beyond initial improvements in acetabular cover.
Abstract:
A prospective trial was carried out to assess the outcome of children aged from 2 to 6 weeks with stable but dysplastic hips, treated with abduction splintage or by observation. Forty-four patients with 63 dysplastic hips were entered into the study and allocated into the two treatment groups at random. The ultrasound measured percentage acetabular cover in the splinted group improved in the first 3 months from an average of 32.8 to 54.3%. In the unsplinted group, the increase in cover was from 36.7 to 48.6%. The changes in cover for the splinted group were significantly more than those for the unsplinted group (p < 0.003) There was, however, no significant difference between the two groups in acetabular angle measurements on plain radiographs taken at 3 months. At 24 months, similarly, there was no significant difference in the acetabular angles of the two groups. These results support the view that stable dysplastic hips will correct with growth and that there is no sustained benefit from early splintage.