Reduction of the dislocated hips with the Tübingen hip flexion splint in infants

Yegen, Murat; Atalar, Hakan; Günay, Cüneyd; Yavuz, Osman Yüksel; Uraş, İsmail; Kaptan, Ahmet Yiğit

doi:10.1007/s00264-018-4239-6

Cited by 7 publications

(8 citation statements)

References 20 publications

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“…The reported incidence of avascular necrosis in DDH treated with the Pavlik harness was 0-30% [10,23]. On the contrary, treating DDH with the Tübingen splint was found to be associated with relatively lower incidence of avascular necrosis [18][19][20]. In our study, 3 patients (2.0%) with 3 hips (1.5%) achieved successful treatment outcomes but were found to have mild avascular necrosis by follow-up radiography according to the Bucholz-Ogden classification.…”

Section: Discussioncontrasting

confidence: 47%

Tübingen hip flexion splints for developmental dysplasia of the hip in infants aged 0–6 months

Zhou

Li³

et al. 2020

BMC Pediatr

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Background: Developmental dysplasia of the hip (DDH) is a common disorder in infants. The present study aimed to evaluate the efficacy and safety of the Tübingen hip flexion splints in treating DDH in infants aged 0-6 months. Methods: This is a retrospective study analyzing 259 hips in 195 infants with DDH of Graf type IIc or worse classifications treated between January 2015 and December 2017. Patients were followed up for at least 6 months. Avascular necrosis of the femoral head was diagnosed using plain radiographs at the last follow-up visit according to the Bucholz-Ogden classification. Successful treatment was defined as an improvement of the Graft classification to type I, or an improvement of the International Hip Dysplasia Institute classification to type I in patients aged > 6 months. Results: Treatment was deemed successful in 128 patients (83.7%). Avascular necrosis occurred in 3 patients (3 hips). Univariate analysis showed that late treatment initiation, family history of DDH, Graf type IV and bilateral involvement were independent risk factors for treatment failure (p < 0.05). The receiver operating characteristic curve showed a cutoff value of 12 weeks for age at treatment initiation regarding successful treatment. Logistic regression analysis showed that gender, breech presentation, firstborn, swaddling, birth weight > 3.5 kg, oligohydramnios, foot deformity and torticollis did not affect the success rate of treatment (p > 0.05). Conclusions: The Tübingen splint showed good efficacy and safety in treating DDH in infants aged 0-6 months. Family history of DDH, Graf classification of type IV, bilateral involvement and treatment initiation after 12 weeks of age are risk factors of treatment failure. Trial registration: N/A

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Section: Discussioncontrasting

confidence: 47%

Tübingen hip flexion splints for developmental dysplasia of the hip in infants aged 0–6 months

Zhou

Li³

et al. 2020

BMC Pediatr

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“…The overall treatment success rate with the Tübingen splint in our cohort was 79%. Stable and unstable DDH have a significant difference with a success rate of 93% and 40%, respectively, which is like previously published data in the literature ( 22 , 24 ).…”

Section: Discussionsupporting

confidence: 88%

“…Initially, the device was conceived to treat DDH of types IIb and IIc designed as stable hips according to the Graf classification (Table 1) (18,19). Later on, its use was also expanded to unstable DDH of grade D to grade IV with variable outcomes (19)(20)(21)(22). The indication and treatment success have been confirmed by many authors for stable DDH, but there are still controversies in the literature regarding the treatment of unstable DDH with the Tübingen splint (23,24).…”

Section: Introductionmentioning

confidence: 99%

Comparison of treatment outcomes of stable and unstable developmental dysplasia of the hip with the Tübingen splint

et al. 2022

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BackgroundThe Tübingen splint was initially developed for the treatment of stable developmental hip dysplasia (DDH). Later on, some authors expanded its include for the treatment of unstable DDH, but there remain some controversies in the literature. This study aims to compare the outcome between stable and unstable DDH treated with a Tübingen splint.MethodsEpidemiological data and ultrasonographic data of all infants diagnosed with DDH and initially treated with a Tübingen splint at our institution between May 2017 and February 2020 were assessed retrospectively. We divided the population into stable and unstable hips using the Graf classification. Age at treatment initiation, duration of treatment, complications, and radiological outcome between 12 and 24 months were investigated.ResultsWe included a total of 45 patients (57 hips) affected by DDH treated with the Tübingen splint. Treatment has been successful in 93% of stable hips and only 40% of unstable hips. Radiological outcome at 1-year follow-up significantly correlated with initial Graf classification (p < 0.001).ConclusionThe Tübingen splint is a safe and effective treatment for stable hips, nevertheless, for unstable hips, closed reduction, and spica cast remains the gold standard.

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“…Following screening on the pre-specified criteria, including full text review of retained abstracts, eight articles in English and one in German were included in our analysis. 13 , 14 , 19 - 25 Two of these articles, by Kubo et al 13 , 20 used the same study group with outcomes measured at the mid-term and end-point of the period of follow-up. The flow diagram of study selection is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Ashoor et al 37 evaluated the outcomes across six studies using the THFS (713 children; 1001 hips), reporting a pooled failure rate of 7.79% (0% to 25%), AVN rate of 0.5% (0% to 2.4%) and residual dysplasia rate of 6.7%. 13,19–21,23,25,38 However, they did not stratify the results according to the Graf subtype. 37 Failure of the PH is commonly reported in patients with high or fixed dislocation and subsequent AVN.…”

Section: Discussionmentioning

confidence: 97%

Tübingen hip flexion splint for the treatment of developmental dysplasia of the hip in children younger than six months age: A meta-analysis

Zhi

Xiao

Wan

et al. 2021

Journal of Children's Orthopaedics

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Purpose To investigate the success rate of the Tübingen hip flexion splint (THFS) for the treatment of developmental dysplasia of the hip (DDH), of different severity as per the Graf classification, among infants younger than six months of age. The type and incidence rate of complications associated with THFS treatment were also evaluated. Methods The following databases were searched using keywords and limited for age less than six months: PubMed, Embase, Web of Science, Cochrane Library, and SinoMed, between inception and July 2020. Articles were screened and extracted by two researchers, and the quality of the included literature was evaluated (methodological index for non-randomized studies criteria). R studio 1.3 was used for statistical analysis. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results After screening, eight articles were included in the analysis, contributing 1211 hips (875 patients). The overall success rate of THFS treatment is 91% (95% confidence interval (CI) 0.82 to 0.95). The success rate by Graf type is as follows: type-II, 98% (95% CI 0.94 to 1.00); type-III, 96% (95% CI 0.88 to 1.00); and type-IV, 32% (95% CI 0.18 to 0.47). Complications (24/1211, 2%) included transient femoral nerve palsy (n = 1); avascular necrosis of the femoral head (n = 9) and residual acetabular dysplasia (n = 14). Conclusion THFS treatment is successful for Graf type-II and –III, but low for type-IV, with a low rate of complication. THFS may be an effective treatment option for DDH among infants less than six months of age. However, those with Graf type-IV require close monitoring. Level of Evidence: III

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Reduction of the dislocated hips with the Tübingen hip flexion splint in infants

Cited by 7 publications

References 20 publications

Tübingen hip flexion splints for developmental dysplasia of the hip in infants aged 0–6 months

Tübingen hip flexion splints for developmental dysplasia of the hip in infants aged 0–6 months

Comparison of treatment outcomes of stable and unstable developmental dysplasia of the hip with the Tübingen splint

Tübingen hip flexion splint for the treatment of developmental dysplasia of the hip in children younger than six months age: A meta-analysis

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