Abduction Orthosis Research Articles

Difficult-to-Treat Ortolani-Positive Hip

The aim of this paper was to review the outcomes of treatment of dislocated but reducible (Ortolani-positive) hips. A comparative retrospective review was conducted of all patients aged younger than 6 months who presented for treatment of developmental dysplasia of the hip for two 10-year periods. The inclusion criteria consisted of a clinical evaluation documenting Ortolani-positive examination, no previous treatment, and an initial treatment with Pavlik harness only. Patients with insufficient follow-up, neuromuscular disease, provocative dislocatable hips, or dislocated but not reducible hips were excluded. In group 1 (1984-1994), treatment involved initiation of Pavlik harness and parental education at the time of initial diagnosis. Group 2 (1997-2007) was treated the same as group 1 with the addition of serial orthopaedic office-based ultrasound examinations and use of a hip abduction orthosis in hips remaining unstable after 3 weeks in the Pavlik harness. Records were assessed for successful achievement and maintenance of hip reduction, need for and type of further treatment, and development of avascular necrosis. In group 1, the mean time of follow-up was 28 months. Forty-four (85%) of 52 hips were treated successfully. Eight patients required further operative treatment. In group 2, the mean follow-up to the final evaluation was 34 months. Forty-one (93%) of 44 hips were treated successfully. Three hips required further treatment. There were no documented cases of avascular necrosis in patients treated for orthoses only in either group. In 1994, we presented a series of 52 Ortolani-positive hips (group 1) with a success rate of reduction of 85%. Now, our protocol for treating Ortolani-positive hips has evolved to include serial orthopaedic office-based ultrasound in all patients and use of a hip abduction orthosis in hips remaining unstable after 3 weeks in a Pavlik harness. Three previous studies at major centers reported successful reduction in only 63% to 71%. In group 2, our current success rate of 93% exceeds that previously reported by us and is significantly greater than these 3 previous studies (all P < 0.006). Furthermore, our current treatment module has decreased our rate of open reduction from 10% in group 1 to 5% in group 2. LEVEL OF RELEVANCE: Therapeutic study, level 3.

Prognostic factors and outcome of treatment in Perthes’ disease

This nationwide prospective study was designed to determine prognostic factors and evaluate the outcome of different treatments of Perthes' disease. A total of 28 hospitals in Norway were instructed to report all new cases of Perthes' disease over a period of five years and 425 patients were reported and followed for five years. Of these, 368 with unilateral disease were included in the present study. The hips were classified radiologically according to a modified two-group Catterall classification and the lateral pillar classification. A total of 358 patients (97%) attended the five-year follow-up, when a modified three-group Stulberg classification was used as a radiological outcome measure. For patients over six years of age at diagnosis and with more than 50% necrosis of the femoral head (152 patients), the surgeons at the different hospitals had chosen one of three methods of treatment: physiotherapy (55 patients), the Scottish Rite abduction orthosis (26), and proximal femoral varus osteotomy (71). Of these hips, 146 (96%) were available for the five-year follow-up. The strongest predictor of outcome was femoral head involvement of more or less than 50% (odds ratio (OR) = 7.76, 95% confidence interval (CI) 2.82 to 21.37), followed by age at diagnosis (OR = 0.98, 95% CI 0.92 to 0.99) and the lateral pillar classification (OR = 0.62, 95% CI 0.40 to 0.98). In children over six years at diagnosis with more than 50% of femoral head necrosis, proximal femoral varus osteotomy gave a significantly better outcome than orthosis (p = 0.001) or physiotherapy (p = 0.001). There was no significant difference between the physiotherapy and orthosis groups (p = 0.36), and we found no difference in outcome after any of the treatments in children under six years (p = 0.73). We recommend proximal femoral varus osteotomy in children aged six years and over at the time of diagnosis with hips having more than 50% femoral head necrosis. The abduction orthosis should be abandoned in Perthes' disease.

Ultrasound hip joint screening in newborn infants. Is twin pregnancy a risk factor for dysplasia?

This study aimed at investigating whether twin pregnancy is a risk factor for congenital dysplasia of the hip. From 1987 until 1994 the hips of 3739 (1902 male, 1837 female) newborn were examined by ultrasound (screening) according to Graf's technique. We compared the results of twins and the other newborn (non-twins). The examinations were performed by 19 physicians. 73 (2%) of the newborn were twins (29 male, 44 female). In the group of 3666 non-twins we found the types of hip IIa (alpha < 55 degrees) to IV (Graf's classification) in 237 (6.5%) newborn: 136 (3.7%) right side/183 (5.0%) left side. Only 2 (2.7%) of the 73 twins showed these types of hip. We found 4% (149/3739) breech presentations at birth in the entire group. 3.9% (141/3666) in the group of non-twins and 11% (8/73) cases in the twin group. 5.2% (190/3666) of the non-twins and 2.7% (2/73) of the twins required a treatment with abduction orthosis or Pavlik harness. This report shows that the types of hip IIa (alpha < 55 degrees); IIc; D; IIa, IIb and IV according to Graf and a required treatment in twins was significantly not more frequent than in the other newborn (non-twins), although twins showed more often a breech presentation at birth. The different kind of breech position in twins (hips and knees in flexion, legs and feet parallel) and non-twins (hips in flexion, knees in extension) could be one reason for these results. Besides, non-twins assume their breech position earlier than twins with a consecutively longer period of time of mechanical stress on the hips.

An adjustable shoulder abduction orthosis for the post-operative management of tendon transfers

Transfer of Musculus Latissimus dorsi/M. Teres major to the rotator cuff with or without M. Subscapularis/M. Pectoralis release is a widely used procedure for restoring shoulder abduction and external rotation in squeal of obstetric brachial plexus palsy. After the operation a shoulder abduction orthosis in maximal external rotation and 90 - 100 degrees abduction is utilized following six weeks of immobilization in a shoulder spica cast for protecting the newly transferred muscle from undue elongation. However this in turn may cause contracture of the external rotators. To overcome this problem, a modified shoulder abduction splint with adjustable internal-external rotation/abduction-adduction ranges was developed in the orthotics department of a rehabilitation center. The custom molded adjustable shoulder abduction orthosis is described and the preliminary results are compared with former applications.

A New Dynamic Foot Abduction Orthosis for Clubfoot Treatment

Recurrent clubfoot deformity after successful initial correction with the use of the Ponseti method continues to be a common problem and is often caused by noncompliance with wear of the traditional foot abduction brace. The purpose of this study was to assess the results of a newly designed dynamic foot abduction orthosis in terms of (1) parental compliance and (2) effectiveness in preventing recurrent clubfoot deformities. Twenty-eight patients (49 clubfeet) who were treated with a dynamic foot abduction orthosis in accordance with the Ponseti method were included in this study. Of the 28 patients, 18 had idiopathic clubfeet (31 clubfeet), 2 had complex idiopathic clubfeet (4 clubfeet), 5 had myelodysplasia (8 clubfeet), and 3 were syndromic (6 clubfeet). The mean duration of follow-up was 29 months (range, 24-36 months). Noncompliance was reported in only 2 (7.1%) of the 28 patients in the new orthosis compared with the authors' previously reported 41% (21/51) noncompliance rate in patients treated with the use of the traditional foot abduction brace. The two patients in this study, in which parents were noncompliant with orthosis wear, developed recurrent deformities. There were 2 patients (7%) who experienced skin blistering in the new orthosis compared with 12 (23.5%) of 51 patients who experienced blistering with the use of traditional abduction brace in the authors' previously reported study. Logistic regression modeling compliance and recurrence revealed that noncompliance with the foot abduction orthosis was most predictive of recurrence of deformity (odds ratio, 27; 95% confidence interval, 2.2-326; P = 0.01). The articulating foot abduction orthosis is well tolerated by patients and parents and results in a higher compliance rate and a lower complication rate than what were observed with the traditional foot abduction orthosis.

Radiographic Evaluation of Idiopathic Clubfeet Undergoing Ponseti Treatment

Background: The Ponseti method for treatment of idiopathic clubfeet involves the use of serial casts, percutaneous Achilles tenotomy in most cases, and bracing with an abduction orthosis to prevent relapse. Although Ponseti recommended evaluation of the infant clubfoot strictly by palpation, many orthopaedic surgeons still rely on radiographs for decision-making during treatment. The aim of this study was to document with radiographs the effect of percutaneous Achilles tenotomy as described by Ponseti. Methods: We conducted a study of idiopathic clubfeet treated, at two centers, with the Ponseti method, including percutaneous Achilles tenotomy. Cast treatment was started within three weeks after birth, and radiographs were made before and after the tenotomy. Lateral radiographs with the foot in maximal dorsiflexion at the ankle were made for all patients, and anteroposterior radiographs of the foot were made at one center. The lateral tibiocalcaneal angle, the anteroposterior talocalcaneal angle, and the lateral talocalcaneal angle were measured on the radiographs. Foot dorsiflexion at the ankle was evaluated clinically. The results from both centers were evaluated separately and in combination. Results: Lateral dorsiflexion radiographs that showed the foot and ankle were evaluated for eighty-seven clubfeet, and anteroposterior radiographs that showed the foot were evaluated for sixty-five clubfeet. The mean improvement in the lateral tibiocalcaneal angle after the tenotomy was 16.9°. The mean change in the anteroposterior talocalcaneal angle was 2.1°, and the mean change in the lateral talocalcaneal angle change was 1.4°. The mean increase in clinically measured dorsiflexion after the tenotomy (in sixty-five feet) was 15.1°. Only the lateral tibiocalcaneal angle and dorsiflexion as measured clinically changed significantly after the Achilles tenotomy (p < 0.05). When the results at each center were analyzed separately, they were found to be nearly identical. Conclusions: The increase in the lateral tibiocalcaneal angle after Achilles tenotomy is essentially the same as the increase in ankle dorsiflexion seen on clinical examination. The anteroposterior and lateral talocalcaneal angles are not influenced significantly by the tenotomy. Radiographs confirmed that the additional dorsiflexion obtained from the percutaneous Achilles tenotomy is true dorsiflexion occurring in the ankle and hindfoot and not in the midfoot. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Radiographic Evaluation of Idiopathic Clubfeet Undergoing Ponseti Treatment

The Ponseti method for treatment of idiopathic clubfeet involves the use of serial casts, percutaneous Achilles tenotomy in most cases, and bracing with an abduction orthosis to prevent relapse. Although Ponseti recommended evaluation of the infant clubfoot strictly by palpation, many orthopaedic surgeons still rely on radiographs for decision-making during treatment. The aim of this study was to document with radiographs the effect of percutaneous Achilles tenotomy as described by Ponseti. We conducted a study of idiopathic clubfeet treated, at two centers, with the Ponseti method, including percutaneous Achilles tenotomy. Cast treatment was started within three weeks after birth, and radiographs were made before and after the tenotomy. Lateral radiographs with the foot in maximal dorsiflexion at the ankle were made for all patients, and anteroposterior radiographs of the foot were made at one center. The lateral tibiocalcaneal angle, the anteroposterior talocalcaneal angle, and the lateral talocalcaneal angle were measured on the radiographs. Foot dorsiflexion at the ankle was evaluated clinically. The results from both centers were evaluated separately and in combination. Lateral dorsiflexion radiographs that showed the foot and ankle were evaluated for eighty-seven clubfeet, and anteroposterior radiographs that showed the foot were evaluated for sixty-five clubfeet. The mean improvement in the lateral tibiocalcaneal angle after the tenotomy was 16.9 degrees . The mean change in the anteroposterior talocalcaneal angle was 2.1 degrees , and the mean change in the lateral talocalcaneal angle change was 1.4 degrees . The mean increase in clinically measured dorsiflexion after the tenotomy (in sixty-five feet) was 15.1 degrees . Only the lateral tibiocalcaneal angle and dorsiflexion as measured clinically changed significantly after the Achilles tenotomy (p < 0.05). When the results at each center were analyzed separately, they were found to be nearly identical. The increase in the lateral tibiocalcaneal angle after Achilles tenotomy is essentially the same as the increase in ankle dorsiflexion seen on clinical examination. The anteroposterior and lateral talocalcaneal angles are not influenced significantly by the tenotomy. Radiographs confirmed that the additional dorsiflexion obtained from the percutaneous Achilles tenotomy is true dorsiflexion occurring in the ankle and hindfoot and not in the midfoot. Therapeutic Level IV.

Surgical Treatment of Fractures of the Greater Trochanter Associated with Osteolytic Lesions

A fracture of the greater trochanter through an osteolytic lesion may occur as a late complication after total hip arthroplasty. The optimal treatment for this difficult complication remains controversial. We have treated this problem with internal fixation and allogeneic bone-grafting at the time of revision of a loose acetabular component. We retrospectively reviewed the results of treatment of a fracture through an osteolytic lesion of the greater trochanter in nineteen patients seen from 1996 to 2002. All fractures were treated with morselized allogeneic bone grafts and wire fixation at the time of revision of a failed acetabular component. Postoperative care included the use of an abduction orthosis and protected weight-bearing for at least three months. Follow-up of all patients consisted of radiographic examinations and clinical evaluation with use of the Harris hip score. At an average duration of 3.8 years after the revision, eighteen of the nineteen fractures had healed. The average time to healing was five months. The one treatment failure occurred in a patient who did not comply with the use of an abduction orthosis. The average Harris hip score for all patients improved from 32.5 points preoperatively to 91.2 points at the time of the latest follow-up. Polyethylene wear and recurrent osteolysis of the greater trochanter was noted in one hip at the eight-year follow-up examination. Fractures of the greater trochanter associated with osteolytic lesions can be effectively treated with open reduction, internal fixation with wire, and allogeneic bone-grafting.

A transepiphyseal fracture of the proximal femur combined with a fracture of the mid-shaft of ipsilateral femur in a child: a case report and literature review

The paper describes a rare fracture of proximal femur, classified by Delbet (Am J Surg 6:793-797, 1929) as type I (transepiphyseal type) combined with a fracture of the midshaft of ipsilateral femur in a 2-year-old child. Immediate operation with open reduction and internal fixation was successful. During the postoperative course, avascular necrosis (AVN) of capital femoral epiphysis was seen by bone scan. Applying an abduction orthosis used for the treatment of Legg-Calvè-Perthes disease, collapse of capital epiphysis was prevented. Although, a minimal area of AVN and coxa vara remained, no clinical complaints were recorded at the midterm follow-up. While reviewing the relevant literature, the type-I fractures need to be subclassified into two types for appropriate treatment and/or prediction of outcomes based on their anatomic location of the separated femoral capital epiphysis. In type Ia, femoral capital epiphysis is minimally displaced and within the acetabulum and in type Ib it is widely displaced and lying outside the capsule. Our case is a first case of a type Ib fracture of the proximal femur combined with a fracture of the midshaft of ipsilateral femur. Since the complication rate and the prognosis differed between two subclasses, type-Ib fractures need immediate surgical intervention, our case was prevented from massive AVN. And to prevent the collapse of femoral head following AVN, a major complication of the fracture of proximal femur in child, abduction orthosis is recommended as a choice of treatment.

Surgical Treatment of Fractures of the Greater Trochanter Associated with Osteolytic Lesions

A fracture of the greater trochanter through an osteolytic lesion may occur as a late complication after total hip arthroplasty. The optimal treatment for this difficult complication remains controversial. We have treated this problem with internal fixation and allogeneic bone-grafting at the time of revision of a loose acetabular component. We retrospectively reviewed the results of treatment of a fracture through an osteolytic lesion of the greater trochanter in nineteen patients seen from 1996 to 2002. All fractures were treated with morselized allogeneic bone grafts and wire fixation at the time of revision of a failed acetabular component. Postoperative care included the use of an abduction orthosis and protected weight-bearing for at least three months. Follow-up of all patients consisted of radiographic examinations and clinical evaluation with use of the Harris hip score. At an average duration of 3.8 years after the revision, eighteen of the nineteen fractures had healed. The average time to healing was five months. The one treatment failure occurred in a patient who did not comply with the use of an abduction orthosis. The average Harris hip score for all patients improved from 32.5 points preoperatively to 91.2 points at the time of the latest follow-up. Polyethylene wear and recurrent osteolysis of the greater trochanter was noted in one hip at the eight-year follow-up examination. Fractures of the greater trochanter associated with osteolytic lesions can be effectively treated with open reduction, internal fixation with wire, and allogeneic bone-grafting.

The Ponseti Method for Clubfoot Correction

The Ponseti technique is rapidly becoming the most widely practiced method for initial treatment of congenital clubfeet in infants. It is an easy technique to learn and, when applied accurately, yields excellent results. It consists of gentle manipulation and casting of the feet at weekly intervals. The first cast is applied with the foot supinated and attention directed to elevating the first ray. Subsequent casts are applied to abduct the foot around the head of the talus, taking care never to directly manipulate the calcaneus. At the time of the final cast, the overwhelming majority of infants require a percutaneous Achilles tenotomy to allow sufficient dorsiflexion. The final cast remains in place for three weeks, at which time the infant is placed into a foot abduction orthosis. The orthosis is worn 23 h per day for 3 months and then at night for several years. Good results have been demonstrated at multiple centers and long-term results indicate that foot function is comparable with that of normal feet.

Custom Shoulder Abduction/Rotation Orthosis in Postoperative Management of Brachial Plexus Injury After Modified L???Episcopo Procedure

In Brief Obstetrical brachial plexus injury is rare, occurring with an incidence of 0.1% to 0.4% of live births. Although many infants recover completely, some go on to permanent injury with muscle imbalance, contracture development, and significant functional limitations. Infants with no recovery until after the third month of life may be candidates for microsurgical or reconstructive treatment. Children with chronic upper trunk plexopathy typically exhibit weakness of external rotators, contractures positioning them in internal rotation with limited external rotation range of motion, and limited shoulder extension. Glenohumeral articulation changes may also develop. A modified L’Episcopo procedure improves range of motion, strength, and overall function. Postoperative management involves positioning in maximal external rotation and approximately 100° shoulder abduction. A shoulder abduction orthosis that allows adjustment of abduction and external rotation must be fabricated to ensure accurate position and intimacy of fit during postoperative activity. The thoracic stabilizing component and total contact upper extremity components are connected with an adjustable rod to allow changes in position of abduction and rotation. Preoperative contracture with decreased range of motion limits accuracy of preoperative molding and fitting. Adjustability of position in anticipation of expected improved postoperative position is a necessary part of the orthosis design. Other design challenges also involve adapting components to reflect the size of the patient (as young as 18 months). Preoperative molding and measurement facilitates immediate fitting after cast removal or, in some cases, immediately after surgery and is vital to a successful postoperative protocol. A custom-molded adjustable shoulder abduction/rotation orthosis is described, as used in the modified L’Episcopo procedure postoperative regimen, for four pediatric patients younger than 29 months. Obstetrical brachial plexus injury is rare; however, it leads to significant functional limitations in children who do not experience spontaneous recovery. A modified L’Episcopo procedure in conjunction with a postoperative protocol that includes a custom adjustable rotation/abduction orthosis can produce an exceptional result with significant functional improvement. The University of Michigan’s Department of Orthopaedic Surgery is performing modified L’Episcopo procedures on children as young as 18 months with continued success and adherence to the postoperative protocol. Use of an appropriately fitting custom orthosis as part of the postoperative regimen for an already well-documented successful surgical procedure produces the optimum clinical success and may eliminate the need for postoperative spica casting, which presents significant benefit to the child and the caregiver.

Residual Shortening After Legg-Calve-Perthes Disease, Focusing on the Response of the Ipsilateral Tibia

Residual shortening of the affected limb was measured at skeletal maturity by teleoroentgenograms in 68 patients with Legg-Calve-Perthes disease (LCPD); special attention was paid to the length of the ipsilateral tibia. Of these 68 patients, 38 were treated by abduction orthosis (AO) and 30 by femoral varus osteotomy (FVO). Residual shortening in AO group was significantly greater than that in FVO group. The femoral lengths in both of these groups were similar (12.5 mm in the AO group and 10.1 mm in the FVO group), but the tibial lengths were significantly different (2.5 mm shortening in the AO group and 0.9 mm lengthening in the FVO group). Residual shortening in the patients treated by FVO was less than that in patients treated by AO. The difference is speculated to be caused by the overgrowth of the ipsilateral tibia.

Use of the Foot Abduction Orthosis Following Ponseti Casts

The purpose of this study was to evaluate the need for the use of a foot abduction orthosis (FAO) in the treatment of idiopathic clubfeet using the Ponseti technique. Forty-four idiopathic clubfeet were treated with casting using the Ponseti method followed by FAO application. Compliance was defined as full-time FAO use for 3 months and part-time use subsequently. Noncompliance was failure to fulfill the criteria during the first 9 months after casting. Feet were rated according to the Dimeglio and Pirani scoring systems at initial presentation, at the time of FAO application, and at 6 to 9 months of follow-up. At the time of application, no significant differences in scores were found between the groups. At follow-up, the compliant group's scores were significantly (P < 0.01) better than those of the noncompliant group. From the time of application to follow-up, for the compliant group, the Dimeglio scores improved significantly (P = 0.005). For the noncompliant group, the Dimeglio scores deteriorated significantly (P = 0.001). The feet of patients compliant with FAO use remained better corrected than the feet of those patients who were not compliant. Proper use of FAO is essential for successful application of the Ponseti technique.

Pediatric hip disorders

Purpose of review: To critique the literature over the past year and emphasize advances made that may influence the management of pediatric hip disorders in the future. Recent findings: The Plastizote abduction orthosis is a reasonable alternative to the more traditional Pavlik harness in the management of dislocatable or dislocated but reducible hips in neonates. The success of this device is attributed to moderate abduction and ease of use and acceptance by the parents. The importance of an ossific nucleus before reduction of developmental dysplasia of the hip continues to be debated. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage, designed to specifically examine glycosaminoglycan changes in articular cartilage, could provide a valuable means of monitoring the status of articular cartilage and predict the progression of hip arthrosis. A review found that the optimal time for containment surgery for Perthes disease is during the stage of sclerosis or early fragmentation. Soft tissue release combined with unloading of the femoral head with distraction may improve function in patients with late-onset Perthes disease. The morbidity of pelvic osteomyelitis has increased over the past decade, perhaps because of the increased virulence of offending organisms. The development of clinical practice guidelines has been a major emphasis of the movement toward evidence-based medicine. A standardized management process for specific clinical conditions such as septic arthritis may improve the process of care and clinical outcomes. The use of a trochanteric starting point has proved to be a safe alternative for the management of femoral shaft fractures in skeletally immature adolescents. Summary: The articles in this review were selected for clinical relevance, quality, and controversy. This review looks specifically at studies that address the prevention, diagnosis, and treatment of the most common pediatric hip disorders.

Comparison between braced and non-braced Legg–Calvé–Perthes-disease patients: a radiological outcome study

Twenty-three hips of 23 Legg–Calvé–Perthes-disease (LCPD) patients treated with abduction orthosis and 28 hips of 25 non-braced LCPD patients were evaluated radiologically retrospectively. The mean age of the brace group was 6.82 years and the mean follow-up was 12.30 years. The mean age and mean follow-up were 7.03 and 17.85 years for non-braced patients, respectively. The hips were evaluated according to lateral pillar classification. There were eight Herring A, 15 Herring B and five Herring C hips in the non-braced patients group; and there were five Herring A, 11 Herring-B and seven Herring C hips in the brace group. The groups were similar in terms of mean age, mean follow-up, sex distribution and lateral pillar grade. Patients' end results were evaluated according to Stulberg classification. All Herring A patients healed with Stulberg class 1 or 2, either braced or non-braced. Fifty-three percent of non-braced hips and 65% of the hips treated with brace healed with satisfactory radiological outcome. There were no significant differences between the groups in terms of end result. The overall results of this study suggest that Herring's lateral pillar classification is a useful system for the prediction of the long-term outcome of the disease and that there was no significant difference between the braced and non-braced patients in terms of radiological end result.

Plastazote abduction orthosis in the management of neonatal hip instability.

Since 1987, 113 consecutive newborns with either Ortolani-positive or provocative-positive hip examinations in the newborn nursery have been treated with a Plastazote hip abduction orthosis when diagnosed and followed to determine if the method was safe, effective, and easy to use. Ortolani-positive hips often had bilateral abnormalities in the hip examination, were frequently associated with breech position, and were anatomically more dysplastic than those hips that were unstable by provocative testing. No patient developed ischemic necrosis during follow-up. Only two had additional treatment of their unstable hips. The rest had excellent results. Parents and caregivers found the device easy to use. The orthosis is recommended as the primary method for managing newborns with clinical instability to either the provocative or Ortolani test as being safe, effective, and easy to use across all skill levels.

Plastazote Abduction Orthosis in the Management of Neonatal Hip Instability

Plastazote Abduction Orthosis in the Management of Neonatal Hip Instability

Use of an Abduction Brace for Developmental Dysplasia of the Hip After Failure of Pavlik Harness Use

The authors reviewed the records of 15 infants who were treated with an abduction brace after Pavlik harness use for developmental dysplasia of the hip (DDH) failed. Failure was defined as persistent dislocation or instability of the hip. Thirteen of these 15 patients had resolution of DDH with the use of an abduction brace. The median time spent in the brace before stabilization of examination findings was 24 days; the median time in the brace before normalization of ultrasound parameters was 46 days. There were no complications with regard to use of the abduction orthosis. At final follow-up of an average of 3 years and 7 months, no patient had undergone surgery and no patient had residual dysplasia or avascular necrosis of the hip. The two patients in whom both the Pavlik harness and abduction brace failed went on to successful closed reduction and spica cast application.

Effects of the hip abduction orthosis on muscle activity in children with Cerebral Palsy

Hip abduction orthoses are commonly used as adjuncts to create a symmetrical and stable sitting position for children with spastic diplegia. This study investigated how activity in m. Adductor longus, m. Rectus femoris, m. Gastrocnemius and m. Erector spinae was affected while sitting in a ''functional sitting position'' (FSP) performing five upper extremity tasks under four test conditions, one without hip orthosis and three with the orthosis set at three different spring lengths. The experimental group consisted of four children with spastic diplegia (mean age 4 years), while five healthy children (mean age 7 years) served as controls. The initial hip abduction angle adopted spontaneously by each child was measured by a goniometer. Muscle activity was measured by surface electromyography (EMG) during three minutes under each test condition. The children in the experimental group were also assessed from videofilms with the Sitting Assessment Scale (SAS) and the SAS scores were compared to the EMG results. The results of the study failed to demonstrate significant difference in EMG voltage under different sitting conditions, without or with hip abduction orthosis adjusted to varying hip abduction positions. This may imply that if a functional sitting position is assured, further addition of an orthosis is not needed. Follow-up study on a larger group of children with CP may be advisable.