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Over-head traction before closed reduction of developmental dislocation of the hip: an analysis of indications
Insights
Over-head traction is effective for treating developmental dislocation of the hip (DDH) in infants under 12 months. Its effectiveness decreases in older children, with surgery often needed for those over 12 months.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Background:
- Developmental dislocation of the hip (DDH) requires effective treatment strategies.
- Ultrasonography has improved DDH diagnosis, enabling earlier intervention.
- The role of pre-reduction over-head traction in DDH treatment outcomes needs further analysis.
Purpose of the Study:
- To evaluate the importance of over-head traction before closed reduction in DDH treatment.
- To assess treatment outcomes in relation to patient age at intervention.
- To analyze the impact of ultrasonography on DDH diagnosis and treatment.
Main Methods:
- Retrospective study of 32 infants (39 hips) with DDH treated between 1988-2002.
- All patients received over-head traction followed by closed reduction and cast immobilization.
- Outcomes were assessed over a 1.5-14 year follow-up, with subgroup analysis by age (<12 months vs. >12 months).
Main Results:
- Primary closed reduction was successful in 92% of hips.
- Long-term success (no re-operation) was achieved in 56% of hips.
- Treatment before 12 months showed better outcomes (73% vs. 27%), with 21% developing avascular necrosis (AVN).
Conclusions:
- Over-head traction is beneficial for DDH treatment in children under 12 months.
- The efficacy of over-head traction diminishes in children older than 12 months.
- The study could not determine if over-head traction reduces the risk of AVN.
Abstract:
Background. The aim of this study is to analyze the importance of over-head traction before closed reduction in the treatment of developmental dislocation of the hip (DDH), by evaluating treatment outcome after the introduction of ultrasonography in the diagnosis of DDH. Material and methods. We studied 32 infants with 39 dislocated hips, treated in our hospital in the years 1988-2002. In all cases treatment consisted in over-head traction, followed by closed reduction and plaster-cast immobilization for 6 weeks. The follow-up period ranged from 1.5 to 14 years. Treatment outcome was assessed immediately after cast removal, 6 and 12 weeks afterwards, and a final follow-up. The patient group was analyzed as a whole and also divided in two subgroups: below and above 12 months of age. Results. Primary reduction was successful in 36 of 39 hips (92%), but by the last check-up only 22 hips (56%) did not require re-operation. There were 16 hips (73%) treated with over-head traction before 12 months of age and 6 hips (27%) treated after 12 months of age. In 17 hips, conservative treatment was unsuccessful and surgery was required. Signs of AVN were found in 8 hips (21%). Conclusions. Over-head traction seems to give satisfactory results in the treatment of DDH in children under 12 months of age, after whcih age its effectiveness diminishes. It was not possible to ascertain whether or not over-head traction decreases the risk of AVN.
