1. Failure of Pavlik Harness Treatment in Infants Under 6 Months Old with Dislocated Hips: Short- and Intermediate-Term Results of Subsequent Treatment Modalities.
- Author
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Imerci, Ahmet, Thacker, Mihir M., and Bowen, James Richard
- Subjects
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HIP joint radiography , *HIP joint dislocation , *OPEN reduction internal fixation , *CLOSED fractures , *SPLINTS (Surgery) , *T-test (Statistics) , *BONE diseases , *FISHER exact test , *TREATMENT effectiveness , *ORTHOPEDIC apparatus , *ORTHOPEDIC casts , *DESCRIPTIVE statistics , *CHI-squared test , *HIP joint , *JOINT dislocations , *SUBLUXATION , *MEDICAL records , *ACQUISITION of data , *TREATMENT failure , *NEEDS assessment , *DATA analysis software , *PATIENT aftercare , *TIME , *OPERATING rooms , *OSTEONECROSIS , *DISEASE complications , *CHILDREN - Abstract
Objective: This study aimed to determine the short- and medium-term outcomes of hip dislocation in infants who failed Pavlik harness therapy and were subsequently treated with brace, closed reduction (CR) or open reduction (OR) before 6 months of age. Methods: Fifty infants (66 hip dislocations) who failed Pavlik harness therapy between 2000 and 2018 and were treated with a rigid abduction brace or undergoing a CR or OR/cast were evaluated. All demographic data obtained from the medical system, developments and complications during the follow-up and treatment process were recorded and evaluated. Results: Fifty infants (66 hips) with dislocated hips failed Pavlik harness therapy. Of these, 9 infants (12 hips) underwent rigid abduction splint therapy: 9 hips were successful, 2 hips had CR and 1 had OR. Thirty-eight infants (51 hips) had index CR, of which 3 (3 hips) failed and had OR. Radiographs of 49 hips (44 patients) were normal at the final evaluation. Pavlik harness therapy starting after 3 weeks (P = 0.028) and unilateral dislocations (P = 0.028) increased the risk of needing operating room. There was an association between OR and avascular necrosis (P = 0.025), but not between OR and other complications—dysplasia and re-dislocation/subluxation (P = 0.257 and P = 0.508, respectively). Conclusion: Closed treatment of hip dislocation is possible in most babies who fail Pavlik treatment. Babies who are started on Pavlik therapy after 3 weeks of age may be at increased risk of needing an operating room. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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