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Brachial plexus palsy as a complication of Pavlik harness use
1Department of Orthopaedic Surgery, Children's Hospital of Boston, Massachusetts.
Insights
Pavlik harness treatment for hip subluxation in infants can potentially cause brachial plexus injury due to downward strap pull. Prompt discontinuation of the harness led to rapid recovery of upper extremity motor function.
Area of Science:
- Pediatric Orthopedics
- Neonatal Care
- Neurology
Background:
- Persistent hip subluxation in infants often requires orthopedic intervention.
- The Pavlik harness is a common treatment for developmental dysplasia of the hip.
- Early diagnosis and management are crucial for optimal infant outcomes.
Observation:
- A 2.75-month-old infant presented with persistent hip subluxation.
- Pavlik harness treatment was initiated but continued despite concerns.
- A new onset of left upper extremity dysfunction was observed during treatment.
Findings:
- Radiographs revealed no underlying bony abnormalities.
- The infant's upper extremity motor function significantly declined.
- A brachial plexus injury, likely from harness strap traction, was suspected as the cause.
Implications:
- The Pavlik harness may pose a risk of brachial plexus injury in infants, particularly larger ones.
- Close monitoring for neurological complications during harness treatment is essential.
- Discontinuation of the harness resulted in swift and complete recovery of motor function, highlighting the reversible nature of the injury.
Abstract:
A 2.75-month-old male infant was referred to our institution due to persistent hip subluxation despite 3 weeks of treatment in a Pavlik harness. Harness treatment was continued for 2 more weeks until it was noted that his left upper extremity function, which had been normal previously, had changed. Radiographs showed no bony abnormality. A compression or traction injury to his brachial plexus from the downward pull of the harness straps, possibly related to his relatively large size, was believed to be causative. Use of the harness was discontinued immediately, and his upper extremity motor function quickly returned to normal.
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