The effectiveness of preliminary traction in the treatment of congenital dislocation of the hip

Autor: Martina Marsiolo, Ernesto Ippolito, Kristian Efremov, Alessandro Caterini, Fernando De Maio, Pasquale Farsetti
Rok vydání: 2021
Předmět:
Male
Congenital dislocation of the hip (CDH)
medicine.medical_specialty
genetic structures
Sports medicine
Radiography
medicine.medical_treatment
Avascular necrosis
Avascular necrosis (AVN)
Settore MED/33
03 medical and health sciences
Femoral head
0302 clinical medicine
Femur Head Necrosis
Risk Factors
Traction
Developmental dislocation of the hip (DDH)
Preoperative Care
medicine
Humans
Orthopedics and Sports Medicine
030212 general & internal medicine
Hip Dislocation
Congenital
Reduction (orthopedic surgery)
Retrospective Studies
Orthopedic surgery
030222 orthopedics
Trauma Severity Indices
business.industry
Incidence (epidemiology)
Age Factors
Infant
Traction (orthopedics)
medicine.disease
eye diseases
Surgery
Treatment Outcome
Preliminary traction
medicine.anatomical_structure
Child
Preschool
Female
Original Article
sense organs
business
RD701-811
Zdroj: Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology
Journal of Orthopaedics and Traumatology, Vol 22, Iss 1, Pp 1-7 (2021)
ISSN: 1590-9999
1590-9921
DOI: 10.1186/s10195-021-00586-8
Popis: Background Historical papers on the treatment of congenital dislocation of the hip suggest the use of preliminary traction to facilitate closed reduction or to decrease the risk of avascular necrosis (AVN) of the femoral head. In the 1980s, some authors questioned the role of preliminary traction and suspended its use, yielding satisfactory results. Since then, several studies called into question this method, and some authors have continued to recommend preliminary traction while other authors have discouraged its use. Materials and methods We reanalysed the full set of radiographs of 71 hips (52 patients) surgically treated by a medial approach after 4 weeks of preoperative longitudinal traction. The mean age at operation was 16 months. Before and after traction, the height of the dislocation was graded according to the Gage and Winter method. The hips were divided into two groups: group 1, in which the traction was effective, and group 2, in which the traction was not effective. These two groups were statistically analysed regarding the severity of the dislocation, the age of the patient at surgery and the incidence of AVN. Results Preliminary traction was effective in 48 hips (68%, group 1), while it was not effective in the remaining 23 (32%, group 2). The effectiveness of preliminary traction was statistically related to the height of the dislocation and to the age of the patient at surgery, with traction being less effective in more severe dislocations and in older children. The incidence of AVN was statistically lower in group 1 than in group 2. Conclusions In our study population, despite not having a control group, preliminary traction—when effective—seemed to reduce the incidence of AVN in patients surgically treated for congenital dislocation of the hip. The effectiveness of the traction was influenced by the severity of the dislocation and the age of the patient; it worked better for less severe dislocations and in younger children. To reduce hospital costs, traction should be applied at home. Level of evidence 3.
Databáze: OpenAIRE
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