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Treatment of congenital dislocation of the hip. Management before walking age
1Dept. of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis 46223.
Insights
Pre-reduction traction effectively treats congenital hip dislocation in infants. This method achieved a 91% success rate, with no cases of avascular necrosis reported, offering a safe and effective treatment option.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Developmental Orthopedics
Background:
- Congenital hip dislocation (CHD) requires effective management in infants.
- While Ortolani-positive cases are managed with splints or harnesses, Ortolani-negative cases present unique challenges.
- A standardized pre-reduction traction protocol is needed for Ortolani-negative CHD.
Purpose of the Study:
- To assess the efficacy of a pre-reduction traction method for treating complete, congenital hip dislocation in infants.
- To evaluate the success rate and complication profile of this traction-based treatment protocol.
Main Methods:
- Sixty-six infants (85 hips) with Ortolani-negative CHD underwent pre-reduction traction.
- Traction involved 90-degree hip flexion and gradual abduction to 70 degrees over 10-14 days, with cross traction added if needed.
- Following traction, closed reduction under anesthesia and immobilization in a double hip spica were performed, followed by a divarication splint.
Main Results:
- The traction/reduction program was effective in 91% of cases (60/66 patients).
- Six patients (10 hips) required open surgery due to persistent instability.
- No incidence of avascular necrosis was observed based on established criteria.
Conclusions:
- Pre-reduction traction is a highly effective method for treating congenital dislocation of the hip in infants.
- This conservative approach significantly reduces the need for open surgery and avoids avascular necrosis.
- The described traction and reduction protocol offers a safe and successful treatment strategy for this condition.
Abstract:
Neonatal infants with Ortolani-positive dislocated hips are easily managed by reduction and maintenance of the reduction using a divarication splint, cast, or Pavlik harness. Sixty-six patients with 85 complete, congenitally dislocated hips (Ortolani negative) unassociated with other neuromuscular disorders were examined to assess a method of prereduction traction in the treatment of congenital dislocation of the hip. Forty of the 66 patients were six months of age or younger at the beginning of traction treatment. The remaining 26 were younger than 12 months of age prior to the treatment protocol. Overhead traction with the hip flexed to 90 degrees was employed. Gradual hip abduction to 70 degrees (140 degrees combined abduction) was accomplished over the next ten to 14 days. If the dislocated hip was still in a station above Hilgenreiner's line, then cross traction was applied to add another vector of force to pull the femoral head distally. At an average of 18 days into the treatment protocol, an examination under anesthesia with closed reduction was performed and the patient immobilized in a double hip spica in the "human" position for six to eight weeks. This was followed by use of an Ilfeld divarication splint for nine months. This traction/reduction program was effective in 91% of these cases (60 of 66). Six patients (ten hips) required an open procedure because of persistent instability in spite of reducibility. To date, there is no incidence of avascular necrosis using the criteria of Salter for whole head avascular necrosis and the criteria of Kalamchi and MacEwen for partial head avascular necrosis.