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Abduction bracing for residual acetabular dysplasia in infantile DDH
Itai Gans1, John M Flynn, Wudbhav N Sankar
1*Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia †The University of Pennsylvania School of Medicine, Philadelphia, PA.
Insights
Part-time abduction bracing significantly improved acetabular index in infants with residual developmental dysplasia of the hip (DDH). This study shows bracing is effective for treating acetabular dysplasia in infants.
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip (DDH)
Background:
- Abduction bracing is a common treatment for residual acetabular dysplasia in infants with acetabular indices (AI) over 30 degrees at 6 months.
- Limited data exist to support the efficacy of part-time abduction bracing for this condition.
Purpose of the Study:
- To determine the efficacy of part-time abduction bracing in treating residual acetabular dysplasia.
- To compare outcomes between braced and unbraced infants with residual acetabular dysplasia.
Main Methods:
- Retrospective review of consecutive patients with developmental dysplasia of the hip (DDH) over 4 years.
- Comparison of two cohorts: infants with residual acetabular dysplasia at 6 months treated with part-time bracing versus observation.
- Acetabular index (AI) measured at 6 months and 1 year of age.
Main Results:
- Seventy-six hips in 52 patients with residual dysplasia at 6 months were analyzed.
- The braced cohort showed a significantly greater improvement in AI (5.3 degrees) compared to the unbraced cohort (1.1 degrees) over 6 months (P<0.001).
Conclusions:
- Part-time abduction bracing significantly improves the acetabular index in infants with residual acetabular dysplasia between 6 and 12 months of age.
- Abduction orthosis use is an effective treatment for improving residual acetabular dysplasia in infants with DDH.
Background:
Abduction bracing is often used to treat residual acetabular dysplasia in infants whose acetabular indices (AI) exceed 30 degrees after 6 months of age. However, little data exist to support this practice. The purpose of this study was to determine the efficacy of part-time abduction bracing in treating residual acetabular dysplasia by comparing a cohort of braced infants with a cohort of unbraced infants.
Methods:
We performed a retrospective review of a consecutive series of patients with developmental dysplasia of the hip (DDH) treated at our institution over 4 years. Children with stable, treated DDH but residual acetabular dysplasia at 6 months of age were identified; those with available anteroposterior pelvic radiographs at 6 months and 1 year of age were included. Patients who required open surgical reduction and those with syndromic or neuromuscular diagnoses were excluded. On the basis of practice variations at our institution, some orthopaedists start bracing when the 6-month radiograph demonstrates an AI≥30 degrees, whereas others do not; we compared these 2 cohorts. Braced patients were instructed to wear an abduction orthosis during nights and naps until follow-up at 1 year of age. The AI at 6 months and 1 year of age for both cohorts were then measured by a single observer and the differences compared.
Results:
Seventy-six hips in 52 patients were identified with residual dysplasia on the 6-month radiograph. Thirty-nine hips (27 patients) were unbraced, 31 hips (21 patients) were braced, and 6 hips (4 patients) were excluded for cross-over. Over a 6-month period, the braced cohort had significantly better improvement in the AI of 5.3 degrees (95% confidence interval, 4.3 to 6.3 degrees) compared to the unbraced cohort which had an improvement in the AI of only 1.1 degrees (95% confidence interval 0.6 to 1.6 degrees) (P<0.001).
Conclusions:
In this comparative analysis of infants with residual acetabular dysplasia treated with abduction bracing or observation, part-time bracing significantly improved the acetabular index between 6 and 12 months of age. Part-time use of an abduction orthosis is effective for improving residual acetabular dysplasia in infants with DDH.
Level Of Evidence:
Level III-retrospective comparative study.
