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Comparison of inpatient and outpatient traction in developmental dislocation of the hip
J Camp1, J A Herring, C Dworezynski
1Desert Orthopaedic Center Research Foundation, Las Vegas, Nevada 89109.
Insights
Outpatient home traction for developmental hip dislocation is as safe as inpatient traction for preventing avascular necrosis (AVN). This study found low rates of severe AVN in both groups, supporting home traction
Area of Science:
- Pediatric Orthopedics
- Skeletal Dysplasias
- Hip Development Disorders
Background:
- Developmental hip dislocation requires effective treatment to prevent complications.
- Avascular necrosis (AVN) is a significant risk following hip dislocation treatment.
- Traction is a common pre-reduction method, but its setting (inpatient vs. outpatient) is debated.
Purpose of the Study:
- To evaluate the impact of outpatient (home) versus inpatient Bryant's skin traction on avascular necrosis (AVN) incidence and severity.
- To compare treatment outcomes for developmental hip dislocation using different traction settings.
Main Methods:
- Retrospective study of 83 hips in 72 children with developmental hip dislocation.
- Comparison of inpatient Bryant's skin traction (40 hips) versus outpatient Bryant's skin traction (43 hips).
- No routine in-traction radiographs were used; treatment success was based on reduction stability and AVN rates.
Main Results:
- A stable closed reduction was achieved in 66% of hips, with 34% requiring open reduction.
- Severe avascular necrosis (Bucholz types II-IV) occurred in 7.5% of the inpatient group (3/40) and 2.3% of the outpatient group (1/43).
- Low rates of severe AVN were observed in both inpatient and outpatient traction groups.
Conclusions:
- Outpatient home traction programs are as safe and effective as inpatient programs for treating developmental hip dislocation.
- Radiographic monitoring of hip station during traction is not essential for achieving comparable safety outcomes.
- Home-based traction offers a viable and safe alternative to inpatient management, potentially reducing healthcare costs and patient burden.
Abstract:
We studied 83 hips in 72 children being treated for developmental hip dislocation to assess the influence of home traction upon the incidence and severity of avascular necrosis (AVN). We compared two types of traction prior to closed or open reduction: inpatient Bryant's skin traction (40 hips), and outpatient (home) Bryant's skin traction (43 hips). No routine in-traction radiographs were taken in either group. After traction, a stable closed reduction was achieved in 55 hips (66%). Open reduction was performed on 28 hips (34%). The rate of severe AVN involving growth disturbance and resultant deformity (Bucholz types II, III, and IV) was low in both traction groups (inpatient, three out of 40, outpatient, one out of 43). These results demonstrate that an outpatient traction program without attention to radiographic hip station is as safe as identically instituted inpatient programs, as well as those that emphasize achievement of a traction reduction or a predetermined hip station.