Results of spica cast in treatment of developmental dysplasia of the hip in children between 6-18 Months
الكلمات المفتاحية:
Developmental dysplasia، Closed reduction، Hip spica cast، Acetabular index، Tönnis classificationالملخص
Background: Developmental dysplasia of the hip (DDH) includes a range of abnormalities from acetabular dysplasia to hip dislocation. Early diagnosis and treatment are essential to achieve good hip function and prevent early degenerative changes. When bracing fails, closed reduction and hip spica casting are commonly used in infants. Delayed treatment may lead to structural changes such as inverted labrum, hypertrophied ligamentum teres, pulvinar tissue, and capsular tightening.
Aim: To evaluate the outcomes of static long-leg hip spica casting in children aged 6–18 months diagnosed with DDH at Misurata Medical Center.
Methods: Patients were treated with adductor tenotomy, closed reduction, and static long-leg hip spica cast. Hips were classified using the Tönnis system, and baseline acetabular index (AI) was grouped as 30°–35°, 36°–40°, and > 40°. Clinical outcomes were assessed with the modified McKay criteria, and radiological results with Severin’s classification.
Results: Thirty-eight hips (29 patients) were evaluated. According to Severin classification, 70% showed good radiological results (grades I–II), while 30% were poor. Based on the modified McKay criteria, 89% achieved good clinical outcomes (types I–II). Avascular necrosis was observed in 3 hips (7.8%). The mean age at reduction was 6 months, and mean follow-up was 5 months. The average immobilization period in spica cast was 90 days.
Conclusion: Closed reduction and static hip spica casting is a safe and effective method for treating DDH in children aged 6–18 months. Outcomes are influenced mainly by the pre-reduction hip position, initial acetabular index, and occurrence of avascular necrosis.
المراجع
(1) Patel H, Canadian Task Force on Preventive Health Care Preventive health care, 2001 update: screening and management of developmental dysplasia of the hip in newborns. CMAJ. 2001; 164:1669–1677. [PMC free article] [PubMed] [Google Scholar]
(2) Harris IE, Dickens R, Menelaus MB. Use of the Pavlik harness for hip displacements. When to abandon treatment. Clin Orthop Relat Res. 1992; 281:29–33. [PubMed] [Google Scholar]
(3) Zionts LE, MacEwen GD. Treatment of congenital dislocation of the hip in children between the ages of one and three years. J Bone Joint Surg Am. 1986;68:829–846.[PubMed] [Google Scholar]
(4) Blockey NJ. Derotation osteotomy in the management of congenital dislocation of the hip. J Bone Joint Surg Br. 1984;66:485–490. [PubMed] [Google Scholar]
(5) Berkeley ME, Dickson JH, Cain TE, Donovan MM. Surgical therapy for congenital dislocation of the hip in patients who are twelve to thirty-six months old. J Bone Joint Surg Am. 1984;66:412–420. [PubMed] [Google Scholar]
(6) Esteve R. Congenital dislocation of the hip. A review and assessment of results of treatment with special reference to frame reduction as compared with manipulative reduction. J Bone Joint Surg Br. 1960;42-B:253–263. [PubMed] [Google Scholar]
(7) Ponseti IV, Frigerio ER. Results of treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1959;41-A:823–846. [PubMed] [Google Scholar]
(8) Kahle WK, Anderson MB, Alpert J, Stevens PM, Coleman SS. The value of preliminary traction in the treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1990;72:1043–1047. [PubMed] [Google Scholar]
(9) Morel G. The treatment of congenital dislocation and subluxation of the hip in the older child. Acta Orthop Scand. 1975;46:364–399. [PubMed] [Google Scholar]
(10) Malvitz TA, Weinstein SL. Closed reduction for congenital dysplasia of the hip. Functional and radiographic results after an average of thirty years. J Bone Joint Surg Am. 1994;76:1777–1792. [PubMed] [Google Scholar]
(11) Chen IH, Kuo KN, Lubicky JP. Prognosticating factors in acetabular development following reduction of developmental dysplasia of the hip. J Pediatr Orthop. 1994;14:3–8. doi: 10.1097/01241398-199401000-00002. [PubMed][CrossRef] [Google Scholar]
(12) Daoud A, Saighi-Bououina A. Congenital dislocation of the hip in the older child. The effectiveness of overhead traction. J Bone Joint Surg Am. 1996;78:30– 40.[PubMed] [Google Scholar]
(13) Severin E. Congenital dislocation of the hip; development of the joint after closed reduction. J Bone Joint Surg Am. 1950;32-A:507–518. [PubMed] [Google Scholar]
(14) Race C, Herring JA. Congenital dislocation of the hip: an evaluation of closed reduction. J Pediatr Orthop. 1983;3:166–172. doi: 10.1097/01241398-198305000- 00004. [PubMed] [CrossRef] [Google Scholar]
(15) Massie WK, Howorth MB. Congenital dislocation of the hip. Part I. Method of grading results. J Bone Joint Surg Am. 1950;32-A:519–531. [PubMed] [Google Scholar]
(16) Thomas CL, Gage JR, Ogden JA. Treatment concepts for proximal femoral ischemic necrosis complicating congenital hip disease. J Bone Joint Surg Am. 1982;64:817–828. [PubMed] [Google Scholar]
(17) Schwartzmann JR, Crego CH., Jr Hamstring-tendon transplantation for the relief of quadriceps femoris paralysis in residual poliomyelitis; a follow-up study of 134 cases. J Bone Joint Surg Am. 1948;30A:541–549. [PubMed] [Google Scholar]
(18) Salter RB, Kostuik J, Dallas S. Avascular necrosis of the femoral head as a complication of treatment for congenital dislocation of the hip in young children: a clinical and experimental investigation. Can J Surg. 1969;12:44–61. [PubMed] [Google Scholar]
(19) Gage JR, Winter RB. Avascular necrosis of the capital femoral epiphysis as a complication of closed reduction of congenital dislocation of the hip. A critical review of twenty years’ experience at Gillette Children’s Hospital. J Bone Joint Surg Am. 1972;54:373–388. [PubMed] [Google Scholar]
(20) Fogarty EE, Accardo NJ., Jr Incidence of avascular necrosis of the femoral head in congenital hip dislocation related to the degree of abduction during preliminary traction. J Pediatr Orthop. 1981;1:307–311. doi: 10.1097/01241398-198111000- 00011.[PubMed] [CrossRef] [Google Scholar]
(21) Stanton RP, Capecci R. Computed tomography for early evaluation of developmental dysplasia of the hip. J Pediatr Orthop. 1992;12:727–730. doi: 10.1097/01241398-199211000-00005. [PubMed] [CrossRef] [Google Scholar]
(22) Brougham DI, Broughton NS, Cole WG, Menelaus MB. Avascular necrosis following closed reduction of congenital dislocation of the hip. Review of influencing factors and long-term follow-up. J Bone Joint Surg Br. 1990;72:557–562. [PubMed] [Google Scholar]
(23) Kalamchi A, MacEwen GD. Avascular necrosis following treatment of congenital dislocation of the hip. J Bone Joint Surg Am. 1980;62:876–888. [PubMed] [Google Scholar]
(24) Pospischill R, Weninger J, Ganger R, Altenhuber J, Grill F. Does open reduction of the developmental dislocated hip increase the risk of osteonecrosis? Clin Orthop Relat Res. 2012;470:250–260. doi: 10.1007/s11999-011-1929-4. [PMCfree article] [PubMed] [CrossRef] [Google Scholar]
(25) Westin GW, Ilfeld FW, Provost J. Total avascular necrosis of the capital femoral epiphysis in congenital dislocated hips. Clin Orthop Relat Res. 1976;119:93– 98.[PubMed] [Google Scholar]
(26) Cooperman DR, Wallensten R, Stulberg SD. Post-reduction avascular necrosis in congenital dislocation of the hip. J Bone Joint Surg Am. 1980;62:247–258. [PubMed] [Google Scholar]
(27) Law EG, Heistad DD, Marcus ML, Mickelson MR. Effect of hip position on blood flow to the femur in puppies. J Pediatr Orthop. 1982;2:133–137. doi: 10.1097/01241398-198202020-00003. [PubMed] [CrossRef] [Google Scholar]
(28) Weiner DS, Hoyt WA, Jr, O’Dell HW. Congenital dislocation of the hip. The relationship of premanipulation traction and age to avascular necrosis of the femoral head. J Bone Joint Surg Am. 1977;59:306–311. [PubMed] [Google Scholar]
(29) Gregosiewicz A, Wośko I. Risk factors of avascular necrosis in the treatment of congenital dislocation of the hip. J Pediatr Orthop. 1988;8:17–19. doi: 10.1097/01241398-198801000-00004. [PubMed] [CrossRef] [Google Scholar]
(30) Clarke NM, Jowett AJ, Parker L. The surgical treatment of established congenital dislocation of the hip: results of surgery after planned delayed intervention following the appearance of the capital femoral ossific nucleus. J Pediatr Orthop. 2005;25:434–439. doi: 10.1097/01.bpo.0000158003.68918.28. [PubMed][CrossRef] [Google Scholar]
(31) Segal LS, Boal DK, Borthwick L, Clark MW, Localio AR, Schwentker EP. Avascular necrosis after treatment of DDH: the protective influence of the ossific nucleus. J Pediatr Orthop. 1999;19:177–184. doi: 10.1097/01241398-199903000- 00008. [PubMed] [CrossRef] [Google Scholar
(32) von Kries R, Ihme N, Altenhofen L, Niethard FU, Krauspe R, et al. (2012)General ultrasound screening reduces the rate of first operative proceduresfor developmental dysplasia of the hip: a case-control study. Pediatr 160:271-27
(33) Graf R (1980) The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop Trauma Surg 97: 117-133.
(34) Aronsson DD, Goldberg MJ, Kling TF, Roy DR. Developmental Dysplasia of thehip. Pediatrics 1994; 94: 201-208 [PMID:8036074]
(35) VitaleMGSkaggs DL. Developmental dysplasia of the hip from 401-411 [six months to four years of age. J Am AcadOrthopSurg2001; 9: PMID: 11730331]
(36) .GuilleJT,Pizzutillo PD, MacEwen GD. Development dysplasia ofthe hip from birth to six months. J Am AcadOrthopSurg2000; 8:232-242 [PMID: 10951112
(37) American Academy ofPediatric Clinical practice guideline:early detection of developmental dysplasia of the hip. Committee onQuality Improvement, Subcommittee on Developmental Dysplasiaof the Hip. American Academy of Pediatrics. Pediatrics 2000; 105:896-905 [PMID: 10742345 DOI: 10.1542/peds.105.4.896]
(38) Schwend.RMShaw BA, Segal LS. Evaluation and treatment ofdevelopmental hip dysplasia in the newborn and infant. PediatrClinNorth Am 2014; 61: 1095- 1107 [PMID: 25439013 DOI: 10.1016/j.pcl.2014.08.008]
(39) Rosendahl K, Markestad T, Lie RT.Ultrasound screening for developmentaldysplasia of the hip in the neonate: the effect on treatment rate and prevalence oflate cases. Pediatrics 1994;94:47-52.
(40) Bialik V, Bialik GM, Blazer S, et al.Developmental dysplasia of the hip: a newapproach to incidence. Pediatrics 1999;103:93-9.
(41) Kerry Dwan,JamieKirkham,Robin W Paton,EmmaMorley,Ashley William. Newton,Daniel C PerrySplinting for the non-operative management of.
(42) developmental dysplasia of the hip (DDH) in children under six months of age Firstpublished: 4 July 2017EditorialGroup: Cochrane Developmental, .
(43) Psychosocial and Learning Problems GroupDOI: 10.1002/14651858.CD012717
(44) LeBel ME, Gallien R. The surgical treatment of teratologic dislocation of the hip. J PediatrOrthop B 2005;14:331-6.
(45) Yamamuro T, Ishida K. Recent advances in the prevention, early diagnosis, and . treatment of congenital dislocation of the hip in Japan. ClinOrthopRelat Res 1984;184: 34-40 [PMID: 6705362 DOI: 10.1097/00003086-198404000-00005]
(46) KutluA, Memik R, Mutlu M, Kutlu R, Arslan A. Congenital dislocation of the hip and its relation to swaddling used in Turkey. JPediatrOrthop1992; 12: 598-602 [PMID: 1517418 DOI: 10.1097/ 01241398-199209000-00006]
(47) vanSleuwenBE, Engelberts AC, Boere-Boonekamp MM, Kuis W, Schulpen TW, L‟Hoir MP. Swaddling: a systematic review.Pediatrics2007; 120: e1097-e1106 [PMID: 17908730 DOI:
(48) PediatricOrthopaedicSocietyofNorthAmerica. [Online resources]. Available from: URL: http: //posna.org/ InternationalHipDysplasiaInstitute. [Online resources]. Available from: URL: http: // hipdysplasia.org
(49) Original Text by Clifford R. Wheeless, III, MD.Last updated by Data Trace Staff on Thursday, August 9, 2012
(50) MassachusettsGeneralHospital DevelopmentalDysplasiaof theHip (DDH) 55 Fruit Street Boston, MA 02114 Phone: 617-726-2000
(51) nottinghamneonatal service staff and neonatal task screen for developmental dysplasia of hip feb 2017
(52) PMCfulltextIntOrthop. 2011 Sep; 35(9): 1359–1367.2011 May7. Doi 10.1007/s00264-011-1257-z
(53) Patel H. Preventive health care, 2001update:screening and management of developmental dysplasia of the hip in newborns.CMAJ2001; 164: 1669-1677 [PMID:11450209]
(54) ShipmanSA, Helfand M, Moyer VA, Yawn BP. Screening for developmental dysplasia of the hip: a systematic literature review for the US Preventive Services Task Force. Pediatrics 2006; 117:e557-e576 [PMID: 16510634 DOI: 10.1542/peds.2005-1597]
(55) MahanST, Katz JN, Kim YJ. To screen or not to screen? Adecision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg Am 2009; 91: 1705-1719 [PMID: 19571094 DOI: 10.2106/JBJS.H.00122]
(56) Neonatal&Gynaecology Community of PracticeEndorsedby: South Australian Maternal
(57) Neonatal ,Hip Screening and Management of Developmental Dysplasia of the Hip Flowchart ISBNnumber: 978-1-74243-844-3 Community of Practice LastRevised: 20/6/2017
(58) MalvitzTA, Weinstein SL. Closed reduction for congenital dysplasia of the hip. Functional and radiographic results after an average of thirty years. J Bone Joint Surg Am 1994; 76: 1777-1792
(59) GillinghamBL, Sanchez AA, Wenger DR. Pelvic osteotomies for the treatment of hip dysplasia in children and young adults. J AmAcadOrthopSurg1999; 7: 325-337 [PMID: 10504359]
(60) Holman J, Carroll KL, Murray KA, Macleod LM, Roach JW.Long-term follow-up of open reduction surgery for developmental dislocation of the hip. J PediatrOrthop2012; 32: 121-124 [PMID: 22327444 DOI: 10.1097/BPO.0b013e3182471aad
(61) Shorter D, Hong T, Osborn DA. Cochrane Review: Screening programmes for developmental dysplasia of the hip in newborn infants. Evid Based Child Health 2013; 8: 11-54 [PMID: 23878122 DOI: 10.1002/ebch.1891]
(62) Viere RG, Birch JG, Herring JA, et al. Use of the Pavlik harness in congenital dislocation of the hip. An analysis of failures of treatment. J Bone Joint Surg Am 1990; 72:238
(63) Harris IE, Dickens R, Menelaus MB. Use of the Pavlik harness for hip displacements. When to abandon treatment. ClinOrthopRelat Res 1992; :29.
(64) Luhmann SJ, Bassett GS, Gordon JE, et al. Reduction of a dislocation of the hip due to developmental dysplasia. Implications for the need for future surgery. J Bone Joint Surg Am 2003; 85-A:239.
(65) JonesDA,Hip screening in the Newborn ,A Practical Guide. Pub Butterworth and Heinemann 1998 .ISBN 0-7506-2764-5NHS Newborn and Infant Physical examination Programme updated 25/11/2010
(66) Mulcahy H, Day MR, Coleman C, O‟Dwyer P, Leahy-Warren P (2016)Developmental Dysplasia of the Hip: A Case Study to Illustrate Public HealthNursing practice. Adv Practice Nurs 2:106. doi:10.4172/apn.1000106
(67) H. Malkawi, “Sonographic monitoring of the treatment of developmental disturbances of the hip by the Pavlik harness,” Journal of Pediatric Orthopaedics Part B, vol. 7, no. 2, pp. 144–149, 1998.
(68) K. Iwasaki, “Treatment of congenital dislocation of the hip by the Pavlik harness.
(69) Mechanism of reduction and usage,” TheJournal of Bone and Joint Surgery— American Volume, vol. 65, no. 6, pp. 760–767, 1983.
(70) D.Atar, W. B. Lehman,Y. Tenenbaum, and A. D. Grant, “Pavlik harness versus
(71) Frejka splint in treatment of developmental dysplasia of the hip: Bicenter Study,” Journal of PediatricOrthopaedics, vol. 13, no. 3, pp. 311–313, 1993.
(72) V. Bialik, “Pavlik‟s method in developmental dysplasia of the hip,”
(73) ActaOrthopaedica et TraumatologicaTurcica, vol. 41, supplement 1, pp. 19–24, 2007.
(74) H. Atalar, U. Sayli, O. Y. Yavuz, I. Uras¸, and H. Dogruel, “Indicators of successful use of the Pavlik harness in infants with developmental dysplasia of the hip,” International Orthopaedics,vol. 31, no. 2, pp. 145–150, 2007.
(75) S. Suzuki, N. Kashiwagi, Y. Kasahara, Y. Seto, and T. Futami,“Avascular necrosis and the Pavlik harness. The incidence of avascular necrosisin three types of congenital dislocation of the hip as classified by ultrasound,” The Journal of Bone and JointSurgery—British Volume, vol. 78, no. 4, pp. 631– 635, 1996.
(76) K. Mostert, N. J. A. Tulp, and R. M. Castelein, “Results of Pavlik harness treatment for neonatal hip dislocation as related to Graf ‟s sonographic classification,” Journal of PediatricOrthopaedics, vol. 20, no. 3, pp. 306–310, 2000.
(77) E. Peled, V. Bialik, A. Katzman,M. Eidelman, and D. Norman, “Treatment of Graf ‟s ultrasound class III and IV hips using Pavlik‟s method,” Clinical Orthopaedics and Related Research, vol. 466, no. 4, pp. 825–829, 2008.
(78) F. Grill, H. Bensahel, J. Canadell, P. Dungl, T. Matasovic, and T. Vizkelety, “The Pavlik harness in the treatment of congenital dislocating hip: report on a multicenter study of the European Paediatric Orthopaedic Society,” Journal of Pediatric Orthopaedics, vol. 8, no. 1, pp. 1–8, 1988.
(79) M. Eidelman, A. Katzman, S. Freiman, E. Peled, and V. Bialik, “Treatment of true developmental dysplasia of the hip using Pavlik‟s method,” Journal of Pediatric Orthopaedics Part B, vol. 12, no. 4, pp. 253–258, 2003.
b. Dessì, M. Crisafulli, E. Vannelli, and V. Fanos Ultrasound in developmental dysplasia of the hip: A screening study in Sardinian newborns Published online 2009 Apr 28. doi: 10.1016/j.jus.2009.02.001PMCID: PMC3553277
(80) 45-PavelKotlarsky, Reuben Haber, Victor Bialik, Mark Eidelman developmental dysplasia of hip what has changed in the last 20 years World J Orthop2015 December 18; 6(11): 886-901ISS
التنزيلات
منشور
كيفية الاقتباس
إصدار
القسم
الرخصة
الحقوق الفكرية (c) 2026 Alhadi Alsaghaier
هذا العمل مرخص بموجب Creative Commons Attribution 4.0 International License.
