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Closed reduction of developmental dislocation of the hip by prolonged traction
1Department of Orthopaedic Surgery, Tohoku University School of Medicine, National Sendai Hospital, Japan.
Insights
Prolonged traction before hip dislocation reduction in children is effective. This method achieves high success rates for closed reduction, minimizes avascular necrosis risk, and reduces further surgeries.
Area of Science:
- Pediatric Orthopedics
- Skeletal Dysplasias
- Hip Development Disorders
Background:
- The effectiveness of pre-reduction traction for developmental hip dislocation is debated.
- Current treatment options carry risks of avascular necrosis and re-dislocation.
Purpose of the Study:
- To evaluate the efficacy of prolonged preliminary traction in treating developmental dislocation of the hip.
- To assess the rates of successful closed reduction, avascular necrosis, and residual subluxation.
Main Methods:
- A cohort of 55 children (62 hips) with developmental dislocation of the hip were treated with prolonged traction (mean 8 weeks).
- Patients were followed for at least two years to monitor for avascular changes in the femoral head.
Main Results:
- A high success rate of 92% (57/62 hips) was achieved for closed reduction.
- Only one hip (1.6%) showed radiological evidence of avascular necrosis of the femoral head.
- Among hips followed to over six years (31 hips), 48% (15 hips) had residual subluxation.
Conclusions:
- Prolonged preliminary traction is a safe and effective method for treating developmental dislocation of the hip.
- This approach significantly reduces the incidence of avascular necrosis and the need for secondary operations.
- While residual subluxation can occur, the overall outcomes support the use of this traction method.
Abstract:
The efficacy of traction before an attempted closed reduction for patients with developmental dislocation of the hip remains controversial. We treated 55 children (62 dislocations of the hip) by preliminary, prolonged traction for a mean of eight weeks. All were followed up for at least two years in order to observe the development of any avascular changes within the femoral head. Of the 55 children, 27 (31 dislocations) were followed up until they were over six years of age. Fifty-seven of the 62 hips (92%) showed a successful closed reduction. Only one had radiological evidence of avascular necrosis of the femoral head. Of the 31 hips which were followed up to over six years of age, 15 (48%) showed residual subluxation. Our method of prolonged preliminary traction leads to a high rate of successful closed reduction, a low incidence of avascular necrosis and a reduced need for secondary operations.
