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Preoperative Gallows traction as an adjunct to hip open reduction surgery: Is it safe and is it effective?
Nicholas C Uren1,2, Julia Judd1, Edward A Lindisfarne1
1Department of Paediatric Orthopaedic Surgery, Southampton Children's Hospital, Southampton, UK.
Insights
Preoperative traction is safe and effective for infants with developmental dysplasia of the hip, significantly improving hip position before surgery. This method supports excellent surgical outcomes and reduces complications, validating its use.
Area of Science:
- Pediatric Orthopedics
- Surgical Innovation
- Hip Dysplasia Management
Background:
- Traction is traditionally used before open reduction for developmental dysplasia of the hip (DDH) to reduce soft-tissue tension.
- Decreased use of traction is noted due to extended hospital stays, potential complications, and limited evidence.
- This study evaluates the safety and efficacy of preoperative traction in DDH treatment.
Purpose of the Study:
- To determine if preoperative traction is a safe intervention for infants with DDH.
- To assess the demonstrable effect of traction on hip reduction before open surgery.
- To quantify the impact of traction on surgical complications and long-term outcomes.
Main Methods:
- Retrospective review of 80 infants undergoing preoperative traction and open reduction for DDH.
- Classification of hip dislocation height using the International Hip Dysplasia Institute system before and after traction.
- Recording of traction-related complications, need for femoral shortening osteotomies, re-dislocation rates, and avascular necrosis incidence.
Main Results:
- Traction significantly improved the median International Hip Dysplasia Institute grade from 4 to 3 (p < 0.00001).
- No neurovascular complications were observed; two infants had minor skin sores, but surgery proceeded.
- Zero patients required femoral shortening osteotomies, with a 0% re-dislocation rate and 96% Severin 1 or 2 at 6-year follow-up.
Conclusions:
- One week of preoperative traction effectively improves hip resting position in high dislocations.
- Traction is safe for infants weighing less than 12 kg.
- Excellent surgical outcomes support the use of traction prior to open reduction for developmental dysplasia of the hip.
Background:
Traction is used at our hospital before open reduction in infants with developmental dysplasia of the hip. Theoretically, it reduces soft-tissue tension, allowing an easier surgical reduction and therefore lower surgical complications. Owing to extended hospital stays, potential complications, and lack of evidence, the use of traction has decreased. This study aims to quantify whether traction is safe and whether it has any demonstrable effect.
Methods:
The perioperative course of 80 patients undergoing preoperative traction and hip open reduction were reviewed. The height of hip dislocation was classified using the International Hip Dysplasia Institute classification system on both radiographs taken before and after traction. Any complications related to traction were recorded, along with the requirement for femoral shortening osteotomies, incidence of re-dislocation, and longer-term rate of avascular necrosis.
Results:
Traction lowered the resting position of the majority of hips, with the median International Hip Dysplasia Institute grade before traction improving from 4 to 3, a statistically significant improvement (p < 0.00001). There were no neurovascular complications. Two babies were complicated with broken skin sores; however, surgery still progressed uneventfully. Zero hips in the cohort required femoral shortening osteotomies to achieve a tension-free reduction, and the re-dislocation rate was 0%. However, 96% of hips were Severin 1 or 2 at 6-year follow-up.
Conclusion:
Notably, 1 week of preoperative traction significantly improves the resting position of the hip in high dislocations. It is safe when used in infants weighing <12 kg, and subsequent surgical outcomes are excellent, thus supporting its use ahead of developmental dysplasia of the hip open reduction surgery.
Level Of Evidence:
Level IV.
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