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Guided abduction traction in the treatment of congenital hip dislocation
J O Tavares1, D H Gottwald, J R Rochelle
1Shriners Hospitals for Crippled Children (Erie Unit), Pennsylvania.
Insights
Guided abduction traction effectively treats congenital hip dislocation in infants, reducing the need for open surgery. This method is particularly useful when other treatments like the Pavlik harness have failed.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Biomedical Engineering
Background:
- Congenital hip dislocation (CHD) is a common pediatric orthopedic condition.
- The Pavlik harness is a standard treatment, but alternative methods are needed for treatment failures or older children.
- Preliminary traction is debated for its efficacy in CHD treatment.
Purpose of the Study:
- To evaluate the effectiveness of guided abduction traction as a primary treatment for congenital hip dislocation.
- To compare the incidence of open reduction in hips treated with guided abduction traction versus those treated without preliminary traction.
Main Methods:
- A retrospective review of 27 hips in 27 children with congenital hip dislocation treated with guided abduction traction between 1979 and 1989.
- Patients' ages ranged from 1 month to 28 months.
- Outcomes assessed included closed reduction success rates, need for open reduction, and complications such as avascular necrosis and irregular ossification.
Main Results:
- Seventy-four percent (20/27) of hips achieved closed reduction with guided abduction traction.
- Closed reduction was not successful in children older than 24 months.
- The incidence of open reduction was lower (26%) compared to a study without preliminary traction (49%).
- Two hips (7%) developed avascular necrosis, and five (19%) had temporary irregular ossification.
Conclusions:
- Guided abduction traction is a valuable treatment for congenital hip dislocation, leading to a reduced need for open reduction.
- Preliminary traction, specifically guided abduction, can decrease the necessity for surgical intervention in CHD.
- Treatment success is age-dependent, with better outcomes in younger children.
Abstract:
Guided abduction is a form of overhead traction conceptually similar to the Pavlik harness. It is used in older children or in children in which the Pavlik harness has failed. The results of 27 congenitally dislocated hips treated by guided abduction traction from December 1979 to June 1989 were reviewed. Ages ranged from 1 month to 28 months. Twenty (74%) of the 27 hips underwent a gentle, often spontaneous, closed reduction, followed by abduction casting and bracing. Two hips developed radiographic evidence of avascular necrosis; five hips developed temporary irregular ossification. Closed reduction was unobtainable in any child older than 24 months. Two children needed additional reconstructive procedures, one an innominate pelvic osteotomy and the other a valgus derotation osteotomy. Both had had open reductions. Recent reports stated that preliminary traction in the treatment of congenitally dislocated hips is of no value. We consider guided abduction traction a valuable treatment modality resulting in a reduced incidence of open reduction. When comparing our results with those of a Salt Lake City study performed without preliminary traction, our incidence of open reduction is lower (26 versus 49%). Our study supports the use of preliminary traction to decrease the need for open reduction in congenitally dislocated hips.
