MRI reveals unrecognized treatment failures after application of Fettweis plaster in children with unstable hip joints

Abstract

We evaluated the success of treatment of unstable hip joints with the Fettweis plaster followed by MRI to detect potential treatment failures. A total of 132 ultrasound-detected unstable hips of type D, III, or IV according to Graf were treated with closed reduction and Fettweis plaster, followed by MRI. We examined 19 type D, 55 type III, and 58 type IV. Mean age at diagnosis was 84.5 days (SD: ± 55.4). Treatment period was 63.2 days (SD: ± 22.2). In 13 cases, the MRI showed a poor reduction. After repetition of this treatment, all 13 showed a concentric reduction. The use of MRI detects 9.8% of treatment failures. We recommend an MRI examination after each closed reduction to ensure the success of the therapy.

Radiological long-term follow-up up to 12 years of initially ultrasound unstable hip types D, III and IV after treatment with the Tübingen splint worn as a plaster

“…Compared to other treatment options for ultrasound unstable hips-such as the frequently used Fettweis plaster or the Pavlik harness-, the stated success rate is comparably good. The Fettweis plaster shows a success rate of 80 to 93% with a low AVN rate < 7.4% over time [18][19][20][21]. However, the Fettweis plaster is applied under anesthesia associated with a higher burden for the patient and it is less comfortable for the parents in taking care for hygiene, etc.…”

Transinguinal Ultrasound versus Magnetic Resonance in Spica Cast after Closed Reduction of Unstable Hips in DDH

“…After closed reduction of unstable or dislocated hips in DDH, the position of the femoral head in spica cast should always be checked [ 5 ]. The rate of persistent dislocation is consistent: in up to 10% of the cases, MRI revealed a persistent hip dislocation after application of Fettweis SC in children with unstable hip joint [ 5 ]. X-rays are an option that could be performed while performing the spica cast and are also widely available.…”

“…The main advantages of the present study include the following: data from consecutive patients were collected prospectively; the control group was based on MR, which is a gold standard for the evaluation of the infant hip [ 5 ]; one surgeon used the same protocol and followed-up every single patient. The main limitations of this study must be acknowledged.…”

“…Once SC has been applied, the position of the head must be evaluated, to check if the hip is reduced or not [ 5 ]. Different techniques are available to verify the position of the femoral head in SC: X-ray [ 6 ], computer tomography (CT) [ 7 , 8 , 9 ], magnetic resonance (MR) [ 5 , 6 , 10 , 11 ] and ultrasound (US) [ 10 , 12 ].…”

“…Once SC has been applied, the position of the head must be evaluated, to check if the hip is reduced or not [ 5 ]. Different techniques are available to verify the position of the femoral head in SC: X-ray [ 6 ], computer tomography (CT) [ 7 , 8 , 9 ], magnetic resonance (MR) [ 5 , 6 , 10 , 11 ] and ultrasound (US) [ 10 , 12 ]. According to Graf’s technique, ultrasound examination should be performed in a frontal standard plane, approaching the hip laterally and avoiding tilting errors of the probe [ 13 ] ( Figure 1 ); however, Graf’s method is not applicable in the presence of a SC.…”