Over-head traction before closed reduction of developmental dislocation of the hip: an analysis of indications.
Background. The aim of this study is to analyze the importance of over-head traction before closed reduction in the treatment of developmental dislocation of the hip (DDH), by evaluating treatment outcome after the introduction of ultrasonography in the diagnosis of DDH. Material and methods. We studied 32 infants with 39 dislocated hips, treated in our hospital in the years 1988-2002. In all cases treatment consisted in over-head traction, followed by closed reduction and plaster-cast immobilization for 6 weeks. The follow-up period ranged from 1.5 to 14 years. Treatment outcome was assessed immediately after cast removal, 6 and 12 weeks afterwards, and a final follow-up. The patient group was analyzed as a whole and also divided in two subgroups: below and above 12 months of age. Results. Primary reduction was successful in 36 of 39 hips (92%), but by the last check-up only 22 hips (56%) did not require re-operation. There were 16 hips (73%) treated with over-head traction before 12 months of age and 6 hips (27%) treated after 12 months of age. In 17 hips, conservative treatment was unsuccessful and surgery was required. Signs of AVN were found in 8 hips (21%). Conclusions. Over-head traction seems to give satisfactory results in the treatment of DDH in children under 12 months of age, after whcih age its effectiveness diminishes. It was not possible to ascertain whether or not over-head traction decreases the risk of AVN.
Jarosław
J
Czubak
Adam
A
Czwojdziński