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6 Weeks with the von Rosen splint is sufficient for treatment of neonatal hip instability
Henrik Lauge-Pedersen1, Johan Gustafsson, Gunnar Hägglund
1Department of Orthopedics, Lund University Hospital, Lund, Sweden. Henrik.Lauge-Pedersen@ort.lu.se
Insights
A 6-week von Rosen splint treatment effectively prevents developmental dysplasia of the hip (DDH) in newborns. This approach significantly reduces late hip dislocations and dysplasia, ensuring better long-term outcomes for infants with unstable hips.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip (DDH)
Background:
- Optimal treatment duration for unstable neonatal hips remains debated.
- A 10-year hospital protocol utilizes a 6-week von Rosen splint for all unstable hips (subluxatable, Barlow-positive, Ortolani-positive).
Purpose of the Study:
- To evaluate the efficacy of a standardized 6-week von Rosen splint treatment program for unstable neonatal hips.
- To assess the long-term outcomes, including late dysplasia and dislocation, in infants treated with this protocol.
Main Methods:
- Retrospective analysis of 32,171 live births between 1988 and 1997.
- Diagnosis and treatment of 247 infants with clinically unstable hips using a von Rosen splint for 6 weeks.
- Radiographic follow-up conducted on 223 children after 5-15 years.
Main Results:
- Only one patient (0.4%) required operative treatment for a dislocated hip after initial splinting.
- One patient who did not adhere to the treatment program developed hip dislocation at age 3.
- Four patients needed treatment beyond the standard 6 weeks.
- No cases of late hip dysplasia or dislocation were observed at long-term follow-up in the treated cohort.
Conclusions:
- A 6-week treatment with the von Rosen splint is highly effective in preventing late hip dysplasia and dislocation.
- The current screening and treatment protocol demonstrates excellent long-term results for managing unstable neonatal hips.
- This standardized approach minimizes the need for further interventions and adverse outcomes in developmental dysplasia of the hip (DDH).
Background:
There is no concensus on the optimal treatment time for unstable hips in the newborn. We analyzed the efficiency of a treatment program that has been used for 10 years at our hospital, in which all unstable hips (subluxatable, Barlow-positive and Ortolani-positive) are treated with the von Rosen splint for 6 weeks.
Patients And Methods:
Between 1988 and 1997, 32,171 children were born alive at the hospital. During this period 247 children had a clinically unstable hip diagnosed. 223 of the 247 children underwent a radiographic follow-up after 5-15 years.
Results:
1 patient with bilateral instability and treated with a splint for 6 weeks showed a dislocated left hip at the radiographic examination at 8 months, which is part of the screening program, and needed operative treatment. 1 patient did not follow the treatment program and showed a dislocated hip at the age of 3. Another 4 patients required more treatment than the 6 weeks with the splint. We found no dysplastic hips at the radiographic follow-up. There was no late dysplasia and there were no late dislocations in children born in Lund between 1988 and 1997 who were diagnosed at other Swedish centers that treat developmental dysplasia of the hip (DDH).
Interpretation:
We conclude that the present screening and 6-week treatment in a von Rosen splint prevent almost all cases of late dysplasia and late dislocation of the hip.
