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Midterm Development of Ultrasound-unstable Hip Joints After Overhead Traction and Treatment With Tübingen Splint and
Lisa Oezel1, Hannes Kubo1, Rüdiger Krauspe2
1Departments of Orthopedics and Trauma Surgery.
Insights
Fettweis plaster treatment for unstable hips shows variable midterm results. Regular radiologic monitoring is crucial to detect potential deteriorations after initial treatment success.
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Background:
- Ultrasound-unstable hips (Type D, III, IV) require early intervention.
- Fettweis plaster is a common treatment modality for neonatal hip instability.
Purpose of the Study:
- To evaluate the midterm success rate of Fettweis plaster treatment for ultrasound-unstable hips.
- To assess hip development from infancy to 4-8 years post-treatment.
Main Methods:
- A cohort of 69 unstable hips treated with Fettweis plaster and splints was analyzed.
- Hip development was monitored using acetabular index (ACI) and center edge angle (CEA) on serial radiographs up to 96 months.
- Radiographic parameters were classified according to Tönnis criteria.
Main Results:
- Initially, 39.1% of hips showed normal findings, 33.2% slight dysplasia, and 27.5% severe dysplasia at 12-24 months.
- Improvement in ACI was observed between serial radiographs, but 20 hip joints deteriorated, primarily after the first follow-up.
- Deteriorations occurred irrespective of the initial hip instability type.
Conclusions:
- Midterm outcomes suggest that Fettweis plaster treatment for unstable hips necessitates ongoing radiologic surveillance.
- Acetabular index and center edge angle are valuable tools for assessing hip joint development in children aged 4-8 years.
Purpose:
The aim of this study was to determine the success rate for treatment of ultrasound unstable hips (type D, III and IV) with Fettweis plaster in terms of a midterm follow-up from the very beginning in the neonatal period until the age of 4 to 8 years.
Methods:
In total, 69 unstable hips, which were successfully treated with Fettweis plaster and after with a flexion-abduction splint, were included into the study. Hip delvelopment was followed by determining the acetabular index (ACI) on routine pelvic radiographs at the age of 12 to ≤24, 24 to ≤48 and 48 to ≤96 months and the center edge angle on the latter, and classifying both angles according to Tönnis.
Results:
After initially successful treatment, the first radiograph at the age of 12 to ≤24 months showed 39.1% (n=27) hips with normal findings, 33.2% (n=23) hips with slightly dysplastic findings, and 27.5% (n=19) hips with severe dysplastic findings. Comparison between first and second radiograph showed improvement of the ACI in 9/69 hips and between the second and third time point in 20/69 hips. Overall, 20 hip joints showed deteriorations. Hereby, 16 deteriorations took place after the first radiograph and 4 after the second radiograph. Deteriorations were observed independently of the initial hip type (D, III, and IV).
Conclusions:
Midterm results indicate that radiologic controls should be provided to detect deteriorations after finishing treatment. ACI and center edge angle are helpful parameters in the assessment of hip joint development in the age range of 4 to 8 years.
Level Of Evidence:
Level III.
