title: Abduction bracing after Pavlik harness failure: an effective alternative to closed reduction and spica casting?
abstract: BACKGROUND
  Previous studies have reported that the use of abduction bracing after Pavlik harness failure in patients with developmental dysplasia of the hip (DDH) is often effective in achieving hip reduction.
  
  
  METHODS
  This is a retrospective study of consecutive patients with DDH at a single institution between 2006 and 2011. Patients in this study met all 4 inclusion criteria: (1) DDH, (2) a dislocated or dislocatable hip, (3) unsuccessful treatment with a Pavlik harness, and (4) subsequent treatment with abduction bracing. Exclusion criteria were dislocated hips associated with neurological, teratologic, syndromic, or other nonidiopathic conditions.
  
  
  RESULTS
  Seven hips met inclusion criteria. Mean age at Pavlik harness initiation was 2.1 months (range, 1 d to 6 mo) and patients spent an average of 1.2 months (range, 0.4 to 2.7 mo) in the harness. After ultrasound demonstrated a persistently dislocated hip, patients were transitioned to an abduction brace and spent an average of 1.3 months (range, 0.1 to 3 mo) in the brace. One hundred percent (7/7) of hips treated with an abduction orthosis failed to reduce and required further treatment; 4 with closed reduction and spica casting, and 3 with open reduction. Patients were followed for an average of 33.6 months (range, 10 to 60 mo), and all patients had stable hips at latest follow-up.
  
  
  CONCLUSIONS
  In this series of 7 patients with developmentally dislocated hips who failed Pavlik harness treatment, subsequent abduction bracing provided no benefit, in contrast to previous studies. All patients who failed Pavlik harness treatment went on to require closed or open reduction of the hip. Abduction bracing may unnecessarily prolong the time to definitive treatment.
  
  
  METHODS
  Case series, level 4.
authors.affiliation: Department of Orthopaedic Surgery, Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Ibrahim
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
authors.forename: Paul D
authors.initials: PD
authors.lastname: Choi
mesh_terms: D002370:Casts, Surgical; D005260:Female; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009989:Orthotic Devices; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014463:Ultrasonography