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6 compared with 12 weeks treatment in the von Rosen splint is sufficient for Barlow and Ortolani positive hips: a
Adam Sand1, Carl Johan Tiderius2, Henrik Düppe2
1Department of Orthopaedics, Lund University, Skåne University Hospital, Sweden. adam.sand@med.lu.se.
Insights
Treating newborns with hip dysplasia using the von Rosen splint for 6 weeks is as effective as 12 weeks for acetabular development. However, closer follow-up is needed for the shorter treatment duration to monitor for complications like hip dislocation.
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Background:
- The von Rosen abduction splint has been used for 12 weeks to treat newborns with hip dysplasia.
- Treatment duration was halved to 6 weeks in 2012.
- The study compares outcomes of 6-week versus 12-week splinting.
Purpose of the Study:
- To investigate if acetabular development at 12 months differs between infants treated with the von Rosen splint for 6 versus 12 weeks.
- To compare complication rates between the two treatment durations.
Main Methods:
- Retrospective study of 99 patients (6-week group) and 138 patients (12-week group).
- Acetabular index (AI) measured at 12 months via pelvic radiographs.
- Complications and additional treatments reviewed up to age 12 months.
- Non-inferiority testing used for comparison.
Main Results:
- Mean AI at 12 months was 25° in both the 6-week and 12-week groups.
- Non-inferiority of the 6-week program was demonstrated (mean difference -0.2°, 95% CI -1.1 to 0.7).
- 8 patients in the 6-week group required additional treatment, including one hip dislocation between 6 weeks and 3 months.
- No additional treatments or complications were observed in the 12-week group.
Conclusions:
- Acetabular development is comparable at 12 months of age regardless of 6 or 12 weeks of von Rosen splint treatment.
- The occurrence of hip dislocation in the 6-week group highlights the need for close follow-up around 3 months of age.
Background And Purpose:
At our institution, newborns with Barlow or Ortolani positive hips have been treated for 12 weeks with the von Rosen abduction splint until 2012 when the treatment length was halved. We investigate whether acetabular development at 12 months of age and complications differ between hips treated with the von Rosen splint for 6 compared with 12 weeks.
Patients And Methods:
99 patients were included in the 6-week program and 138 patients in the 12-week program. We measured the acetabular index (AI) on standard anteroposterior pelvic radiographs taken at 12 months of age. Medical records were reviewed for complications and additional treatments until age 12 months. We used non-inferiority testing with an equivalence margin of 1° with a 95% confidence interval (CI) to compare the 2 groups.
Results:
The mean AI at 12 months in the 6-week group was 25° (CI 24-26) compared with 25° (CI 25-26) in the 12-week group. Non-inferiority was demonstrated for the 6-week program: -0.2° (CI -1.1 to 0.7). In the 6-week group, 8 patients received additional treatment, including 1 hip dislocation that occurred between 6 weeks and 3 months. There were no additional treatments or complications in the 12-week group.
Conclusion:
AI was equal at 12 months of age for patients treated for 6 compared with 12 weeks in the von Rosen splint. The hip dislocation which occurred indicates that follow-up around 3 months of age is indicated.
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