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

February 19, 2016

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

Approximately one to two babies per 1,000 in the United States are born with developmental dysplasia of the hip (DDH). DDH 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), babies with a family history of DDH (parents or siblings), and mothers with oligohydramnios (low levels of amniotic fluid). Currently, the American Academy of Pediatrics recommends ultrasonography screening for DDH in all female babies born in the breech position. Based on the Pediatric Orthopaedic Society of North America criteria about this topic, treatment options depend on the age of the child. Nonsurgical treatment options, such as a Pavlik harness and hip abduction braces are most commonly used to treat patients in whom DDH is diagnosed early (younger than six months). Surgical treatment options, which are performed in older patients, include pelvic osteotomy, femoral osteotomy, and open reduction. Closed reduction of the hip (with or without adductor tenotomy based on arthrography) and spica casting is the preferred treatment option for children with DDH who are older than 6 months and children with DDH in whom a Pavlik harness fails to afford satisfactory concentric reduction. The success rate of closed reduction and spica casting for the management of DDH varies. Correct application of a plaster cast is crucial with regard to successful outcomes. Surgeons should be aware of tips and critical steps to avoid complications, such as osteonecrosis, and ineffective treatment. This video shows the technique commonly used for spica casting, with a focus on tips to achieve the best result. The results of our 10-year follow-up series also are reported. In our series of 45 patients (55 hips) who underwent closed reduction and spica casting since 2000, 10-year follow-up data for 20 patients (25 hips) revealed a mean acetabular index of 33° (normal range in adulthood, 33° to 39°). No osteonecrosis was reported.

Results for "Hip and Pelvis"

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