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Procedure Guide to a Safe and Effective Casting in Developmental Hip Dysplasia

February 19, 2016

Contributors: Luca Labianca, MD; Carlo Iorio, MD; Cosma Calderaro, MD; Daniele Mazza, MD; Antonello Montanaro, MD; Francesco Turturro, MD; Andrea Ferretti, MD

In the United States, approximately 1 to 2 babies per 1,000 are born with developmental dysplasia of the hip (DDH). It usually affects the left hip and is predominant in girls, first-born children, babies born in the breech position (especially with feet up by the shoulders), family history of DDH (parents or siblings), and oligohydraminos (low levels of amniotic fluid). The American Academy of Pediatrics now recommends ultrasound DDH screening of all female breech babies. Following the POSNA criteria about this topic, treatment methods depend on a child's age. Not-surgical treatments such Pavlik Harness and hip abduction braces are most common at early diagnosis (less than six months). Surgical treatments, performed in older patients, are pelvic osteotomy, femoral osteotomy, open reduction. Closed reduction of the hip (with or without adductor tenotomy on the basis of the arthrogram) and spica cast application a remains the preferred treatment for children presenting with developmental dysplasia of the hip after the age of six months and for children in whom the Pavlik harness has failed to provide a satisfactory concentric reduction. The success rate reported in the literature for treatment of the developmentally dislocated hip by closed reduction and spica casting varies. The competence to apply correctly a plaster cast to the child is crucial in influencing the success rate. There are many tips and critical steps that should be known to avoid complications as avascular necrosis or ineffective treatment. The video shows the technique commonly used, with some focus on tips useful to reach the best result. Results of our 10 years follow-up series is also reported. In our series of 45 patients (55 hips), collected since 2000, 20 (25 hips) have a 10 years follow up and showed a mean acetabular index of 33 degrees (normal range in adulthood 33°-39°). No avascular necrosis has been recorded.

Results for "Hip and Pelvis"

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