Principles and techniques in the non-surgical treatment of developmental dysplasia of the hip.
The introduction of ultrasonography in Poland changed the time of diagnosis in children affected by DDH, which in turn resulted in more effective treatment. Early diagnosis of DDH is the most important pre-condition for achieving the best outcome, using a simple, uncomplicated method in the shortest possible time. Delayed diagnosis results in wasting the potential to remodel the acetabular roof, lengthens the duration of treatment, and may cause complications responsible for osteoarthritis. The Pavlik harness is presently the most popular orthosis used for stabilization of unstable, dysplastic hips in infants up to 6 months old. The Pavlik harness should not be used in normal treatment longer than ca. 12 weeks. The ineffectiveness of the Pavlik harness in the first 2-4 weeks of treatment has resulted in changing the method for closed reduction with prior over-head traction. Over-head traction is considered the method of choice in DDH instability for patients from 6 to 12 months of age. Closed reduction should be confirmed by ultrasonography or arthrography. Follow-up after non-surgical treatment should not be terminated until the patient has reached 18 years of age.
Czubak
Jarosław
J