Dataset Information

Single-leg spica provides adequate stability after open reduction in developmental dysplasia of the hip.

ABSTRACT:

Introduction

The late detection of developmental dysplasia of the hip (DDH) will remain a major concern in some parts of the world until effective screening programs become available. With late diagnosis comes the need for open surgical reduction. Surgery is invariably followed by a period of immobilisation in a spica cast to prevent postoperative displacement. The goal of this study is to evaluate the effect of double-leg spica as compared to single-leg spica, on the risk of displacement after unilateral open reduction of the hip.

Materials and methods

This was a retrospective review of DDH patients from 2012 to 2016 and younger than 4 years of age, who had unilateral anterior open reduction. Patients who had one of the following were excluded: neuromuscular diagnosis, the addition of K-wire, and simultaneous bilateral open reductions. Demographic data were collected along with related clinical and radiographic variables. A total of 128 patients (162 hips) met the inclusion criteria; 93 were in the double-leg spica group, and 69 were in the single-leg spica group.

Results

The mean age was 25.4?±?8.1 months and the mean follow-up was 18.6?±?11.6 months. Baseline characteristics were balanced between the two groups. There were three events of redislocation in the double-leg spica group as compared to one redislocation in the single-leg spica group. The difference did not reach statistical significance (p?=?0.637, risk ratio 1.317, CI 0.736-2.356). The difference in subsequent disruption of Shenton's line and hip migration of more than 29% was (p?=?0.395, risk ratio 1.411, CI 0.892-2.234) and (p?=?0.087, risk ratio 0.67, CI 0.417-1.078), respectively. Three patients had a greenstick distal femur fracture after double-leg spica and one after single-leg spica.

Conclusion

These data suggest that including the contralateral hip in the cast after open reduction is not essential as it does not seem to improve stability.

SUBMITTER: Alassaf N

PROVIDER: S-EPMC5773631 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Publications

Single-leg spica provides adequate stability after open reduction in developmental dysplasia of the hip.

Alassaf Nabil N

Archives of orthopaedic and trauma surgery 20171116 2

<h4>Introduction</h4>The late detection of developmental dysplasia of the hip (DDH) will remain a major concern in some parts of the world until effective screening programs become available. With late diagnosis comes the need for open surgical reduction. Surgery is invariably followed by a period of immobilisation in a spica cast to prevent postoperative displacement. The goal of this study is to evaluate the effect of double-leg spica as compared to single-leg spica, on the risk of displacemen ...[more]

PMID: 29147761

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Project description:BackgroundThe risk of avascular necrosis of the femoral head (AVN) after treatment of developmental dysplasia of the hip is associated with the method of reduction. Some authors have suggested that open reduction is a risk factor for AVN; however, this is controversial. To our knowledge, a quantitative comparison of the incidence of AVN between closed and open reduction has not been conducted.MethodsPublished studies were identified by searching PubMed, EMBASE, and the Cochrane Library up to May, 2015, focusing on the incidence of AVN after closed or open reduction for developmental dysplasia of the hip in children aged <3 years. Patients were age-matched who were treated by either closed or open reduction, but without pelvic or femoral osteotomy. Two authors independently assessed eligibility and abstracted data. Discrepancies were discussed and resolved by consensus. We pooled the odds ratios (ORs) and 95% confidence intervals (95%CIs) from individual studies using a random-effects model and evaluated heterogeneity and publication bias.ResultsNine retrospective studies were included in this analysis. The pooled OR for comparing open reduction with closed reduction for all grades of AVN was 2.26 (95%CI = 1.21-4.22), with moderate heterogeneity (I = 44.7%, P = 0.107). The pooled OR for grades II to IV AVN was 2.46 (95%CI = 0.93-6.51), with high heterogeneity (I = 69.6%, P = 0.003). A significant association was also found for the further surgery between open and closed reduction, with a pooled OR of 0.30 (95%CI = 0.15-0.60) and moderate heterogeneity (I = 46.4%, P = 0.133). No evidence of publication bias or significant heterogeneity between subgroups was detected by meta-regression analyses.ConclusionFindings from this meta-analysis suggest that open reduction is a risk factor for the development of AVN compared with closed treatment. Future studies are warranted to investigate how open reduction combined with pelvis and/or femoral osteotomy affects the incidence of AVN.

Project description:BackgroundClosed reduction (CR) is a common treatment for infantile developmental dysplasia of the hip. The purpose of this observational, prospective, multicenter study was to determine the early outcomes following CR.MethodsProspectively collected data from an international multicenter study group was analyzed for patients treated from 2010 to 2014. Baseline demographics, clinical exam, radiographic/ultrasonographic data, and history of previous orthotic treatment were assessed. At minimum 1-year follow-up, failure was defined as an IHDI grade 3 or 4 hip and/or need for open reduction. The incidence of avascular necrosis (AVN), residual dysplasia, and need for further surgery was assessed.ResultsA total of 78 patients undergoing CR for 87 hips were evaluated with a median age at initial reduction of 8 months (range, 1 to 20 mo). Of these, 8 hips (9%) were unable to be closed reduced initially. At most recent follow-up (median 22 mo; range, 12 to 36 mo), 72/79 initially successful CRs (91%) remained stable. The likelihood of failure was unaffected by initial clinical reducibility of the hip (P=0.434), age at initial CR (P=0.897), or previous treatment in brace (P=0.222). Excluding those hips that failed initial CR, 18/72 hips (25%) developed AVN, and the risk of osteonecrosis was unaffected by prereduction reducibility of the hip (P=0.586), age at CR (P=0.745), presence of an ossific nucleus (P=0.496), or previous treatment in brace (P=0.662). Mean acetabular index on most recent radiographs was 25 degrees (±6 degrees), and was also unaffected by any of the above variables. During the follow-up period, 8/72 successfully closed reduced hips (11%) underwent acetabular and/or femoral osteotomy for residual dysplasia.ConclusionsFollowing an initially successful CR, 9% of hips failed reduction and 25% developed radiographic AVN at early-term follow-up. History of femoral head reducibility, previous orthotic bracing, and age at CR did not correlate with success or chances of developing AVN. Further follow-up of this prospective, multicenter cohort will be necessary to establish definitive success and complication rates following CR for infantile developmental dysplasia of the hip.Level of evidenceLevel II-prospective observational cohort.

Dataset Information

Single-leg spica provides adequate stability after open reduction in developmental dysplasia of the hip.

Introduction

Materials and methods

Results

Conclusion

Publications

Single-leg spica provides adequate stability after open reduction in developmental dysplasia of the hip.

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