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Dynamic and Static Splinting for Treatment of Developmental Dysplasia of the Hip: A Systematic Review
Vito Pavone1, Claudia de Cristo1, Andrea Vescio1
1Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy.
Insights
Conservative treatment for developmental dysplasia of the hip (DDH) in infants primarily involves bracing. Dynamic splinting is effective for instability and dislocation in infants under 4-5 months, while static bracing suits stable hips.
Area of Science:
- Orthopedics
- Pediatric Medicine
- Biomedical Engineering
Background:
- Developmental dysplasia of the hip (DDH) is a common pediatric condition.
- Bracing is the standard treatment for reducible DDH in infants under six months.
- Various splint options exist, each with unique benefits and drawbacks.
Purpose of the Study:
- To systematically review current literature on conservative treatments for DDH.
- To analyze evidence regarding different bracing methods for DDH.
Main Methods:
- A systematic review of PubMed and Science Direct databases was conducted.
- Keywords included "developmental dysplasia hip", "brace", "harness", "splint", and "abduction brace".
- Studies of any evidence level reporting clinical or preclinical results for conservative DDH treatment were evaluated.
Main Results:
- 1411 articles were initially identified, with 29 selected after screening and full-text review.
- Commonly studied dynamic splints include the Pavlik harness, Frejka, and Tubingen.
- Static splints evaluated include rhino-style, Ilfeld, and generic abduction braces.
Conclusions:
- Dynamic splinting is a viable option for DDH instability and dislocation, particularly when initiated within 4-5 months of life.
- Dynamic splinting demonstrates a low rate of contraindications.
- Static bracing is effective for stable hips or residual acetabular dysplasia.
Background:
Developmental dysplasia of the hip (DDH) is one of the most common pediatric conditions. The current gold-standard treatment for children under six months of age with a reducible hip is bracing, but the orthopedic literature features several splint options, and each one has many advantages and disadvantages. The aim of this review is to analyze the available literature to document the up-to-date evidence on DDH conservative treatment.
Methods:
A systematic review of PubMed and Science Direct databases was performed by two independent authors (C.d.C. and A.V.) using the keywords "developmental dysplasia hip", "brace", "harness", "splint", "abduction brace" to evaluate studies of any level of evidence that reported clinical or preclinical results and dealt with conservative DDH treatment. The result of every stage was reviewed and approved by the senior investigators (V.P. and G.T.).
Results:
A total of 1411 articles were found. After the exclusion of duplicates, 367 articles were selected. At the end of the first screening, following the previously described selection criteria, we selected 29 articles eligible for full text reading. The included articles mainly focus on the Pavlik harness, Frejka, and Tubingen among the dynamic splint applications as well as the rhino-style brace, Ilfeld and generic abduction brace among the static splint applications. The main findings of the included articles were summarized.
Conclusions:
Dynamic splinting for DDH represents a valid therapeutic option in cases of instability and dislocation, especially if applied within 4-5 months of life. Dynamic splinting has a low contraindication. Static bracing is an effective option too, but only for stable hips or residual acetabular dysplasia.
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