Post-operative radiograph assessment of children undergoing closed reduction and spica cast immobilization for developmental dysplasia of the hip: does experience matter?

Introduction: Besides an effective screening method for developmental dysplasia of the hip, there is certain number of children in whom the condition has been overseen or they have never been screened and the parents have noticed the odd walking pattern in their toddler. Treatment of such patients is controversial. One of the recommended treatment methods because of the short-term hospitalization, but often considered unsuccessful is closed reduction of the hip followed by cast immobilization. Hypothesis: Closed hip reduction in late diagnosed developmental dysplasia of the hip gives good results.  Aim: Our aim in this retrospective study was evaluation of the success of the treatment with closed reduction of hip dislocation in children older than 12 months.  Patients and methods: In the study, we included 20 patients treated at our clinic from June 2004 to May 2017. Of these 20 patients, 8 had bilateral involvement, 12 had unilateral, in a total of 28 hips. In all patients we noted preoperatively the range of movement, the presence of limp, any limb inequality, and hip pain. We used clinical and radiological parameters for evaluation. Clinically, we examined the range of movement, limb inequality as well as limb function and we classified it according to the modified McKay’s criteria. Same examinations were done at 1, 3, and 5 years after closed reduction. Results: At the last follow-up examination, using McKey’s criteria for clinical evaluation we rated the hips in two patients (7%) as grade III, i.e. fair grade, 10 hips (36%) were grade II – rated good, and 16 hips (57%) were evaluated as grade I. In four hips, there were signs of avascular necrosis of the hip, while in one patient the avascular necrosis developed after the closed reduction. Radiographic assessment (Figs 3, 4) using Severin’s scoring system showed no hips with types V and VI, type IV was observed in 7%, type III in 21%, type II in 29%, while most of the hips (12, 43%) were type I. Conclusion: We concluded that the procedure was justified. An advantage of this method is that it is inexpensive; it entails no direct operative changes of the bone structures and gives good results.

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Poor delineation of labrum and acetabular surface on arthrogram is a predictor of early failure of closed reduction in children aged six to 24 months with developmental dysplasia of the hip

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.200132 ◽

2020 ◽

Vol 14 (5) ◽

pp. 372-378

Author(s):

Zhe Yuan ◽

Yiqiang Li ◽

Kai Hong ◽

Jianping Wu ◽

Federico Canavese ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Closed Reduction ◽

Characteristic Curve ◽

Developmental Dysplasia ◽

Abduction Angle ◽

Cast Immobilization ◽

Level Of Evidence ◽

Dysplasia Of The Hip

Purpose The objective of this study was to explore the predictors for failed reduction in children with developmental dysplasia of the hip (DDH) managed by arthrogram, closed reduction (CR) and spica cast immobilization. Methods We retrospectively reviewed the clinical data of patients with DDH treated by CR and cast immobilization (2015-2020), including age, sex, affected side, presence/absence of an ossific nucleus, International Hip Dysplasia Institute classification, the delineation of labrum and acetabular surface on arthrogram, inverted labrum, acetabular index (AI), hip abduction angle and medial dye pool (MDP) distance. Predictors that potentially predicted failure of CR were evaluated by logistic regression analysis, simple t-test, Fisher’s Exact Test and chi-square test. Results In total, 16 out of 187 hips failed to achieve initial CR (8.6%). Gender, age, preoperative AI and poor delineation of arthrogram were candidate predictors for failed CR in children aged six to 24 months with DDH; on the other hand, logistic regression analysis confirmed age and poor delineation of arthrogram significantly predicted failure of CR. Receive operating characteristic curve (ROC) showed MDP less than 6 mm and age higher than 14.5 months significantly increased the failure rate of CR in children aged six to 24 months with DDH. Conclusion Age and poor delineation of labrum and acetabular surface during arthrogram predicted failure of CR in children with DDH. In particular, age > 14.5 months and MDP distance ≥ 6 mm significantly increased the risk of CR failure. Level of evidence III

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Faculty Opinions recommendation of Avascular necrosis following closed reduction for treatment of developmental dysplasia of the hip: a systematic review.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.729524230.793540307 ◽

2017 ◽

Author(s):

Edilson Forlin

Keyword(s):

Systematic Review ◽

Avascular Necrosis ◽

Closed Reduction ◽

Developmental Dysplasia ◽

Dysplasia Of The Hip

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The potential role of the Alsberg angle as a predictor of lateral growth disturbance of the capital femoral epiphysis in children with developmental dysplasia of the hip treated by closed reduction

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.190158 ◽

2020 ◽

Vol 14 (2) ◽

pp. 106-111 ◽

Cited By ~ 1

Author(s):

Ronghua Gui ◽

Federico Canavese ◽

Shuang Liu ◽

Lianyong Li ◽

Lijun Zhang ◽

...

Keyword(s):

Closed Reduction ◽

Normal Values ◽

Developmental Dysplasia ◽

Lateral Growth ◽

Growth Disturbance ◽

Level Of Evidence ◽

Normal Children ◽

One Year ◽

Dysplasia Of The Hip

Purpose Early diagnosis and prevention of lateral growth disturbance of the capital femoral epiphysis is challenging after treatment for developmental dysplasia of the hip (DDH). The aim of the study was to evaluate the radiographic changes of the Alsberg angle (AA) in normal children and those with DDH, and to assess the role of AA as a potential predictor of lateral growth disturbance of the capital femoral epiphysis. Methods AA was measured on the anterior-posterior pelvic radiographs of 1000 normal children ranging in age from one to ten years and in 66 children (92 hips) with DDH treated by closed reduction (CR). A comparative analysis was performed. Results In the normal children, mean AA decreased linearly with age, from 76° at age one year to 65° at age ten years, irrespective of gender and laterality. In children with DDH, the average AA was 81.5°(sd 3.9°; 74° to 87°) prior to CR; it was 75.9° (sd 4.5°; 68° to 83°) in normal children of the same age (p < 0.001). Among the 42 children (64 hips) with successfully and uneventfully treated DDH, AA reached normal values between the ages of five and six years. In contrast, children with lateral growth disturbance of the proximal femur physis (24 children, 28 hips) showed significantly higher AA values in comparison with the age-matched controls. Conclusion In DDH patients with successful CR, AA could be expected to match normal values in children between the ages of five and six years. On the other hand, AA can be used as an early predictor for lateral growth disturbance of the capital femoral epiphysis. Level of Evidence Level III

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Magnetic resonance imaging evaluation of the effects of closed reduction in infants with developmental dysplasia of the hip

Chinese Medical Journal ◽

10.1097/cm9.0000000000001269 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Mi-Fang Li ◽

Jing Zhao ◽

Xiao-Long Tan ◽

Ling-Yan Zhang

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Closed Reduction ◽

Developmental Dysplasia ◽

Resonance Imaging ◽

Imaging Evaluation ◽

Magnetic Resonance Imaging Evaluation ◽

Dysplasia Of The Hip

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Outcomes of closed reduction in patients with developmental dysplasia of the hip incorporating open psoas and adductor release and using short leg cast

10.53350/pjmhs211551529 ◽

2021 ◽

Vol 15 (5) ◽

pp. 1529-1532

Author(s):

M. S. Abdulqader ◽

L. J. Khorsheed ◽

Hwaizi .

Keyword(s):

Soft Tissue ◽

Closed Reduction ◽

Case Series ◽

Developmental Dysplasia ◽

Soft Tissue Release ◽

Plaster Of Paris ◽

Dysplasia Of The Hip ◽

Mid Term Results ◽

Tönnis Grade

Background and objectives: Closed reduction and short leg spica casting are the preferred treatment options for children with developmental dysplasia of the hip. This study aimed to show the efficacy behind a standardized closed reduction for managing patients with developmental dysplasia of the hip with concomitant soft tissue releases when indicated and using a short leg plaster of Paris cast to maintain reduction and reporting mid-term results. Methods: A case series of 95 hips in 84 children aged 6-18 months who had closed reduction, with five years follow up or until next operation, involved in this study. The protocol defines acceptable concentric reduction criteria and the indications for an associated soft tissue release. All the patients were immobilized in a short leg cast for three months. Multiple follow-up radiographs were taken to assess Tönnis grade, Severin grade, acetabular index, and osteonecrosis signs. Results: A total of 48 hips were Tönnis grade 3/4 hips. At one year, 15 reductions couldn’t be maintained, and these patients needed open reduction. Of these 15 failed reductions, 7 patients were Severin 1; others were Severin 2. Of the 80 successful closed reductions, 70 hips were Severin 1. Surgical management for residual dysplasia was offered for 8 hips. Osteonecrosis was seen in 23 hips but was transient in 20. Bilateral hip dislocations and most Tönnis 4 hips were more likely to fail. Two children had severe osteonecrosis. Conclusions: Closed reduction, with subsequent adductor and psoas releases, when indicated and using a short leg plaster of Paris cast for three months, brings about good mid-term results in children with developmental dysplasia of the hip aged 6-18 months. Keywords: Developmental dysplasia of the hip, closed hip reduction, open psoas release, short leg cast.

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