Traction does not decrease failure of reduction and femoral head avascular necrosis in patients aged 6–24 months with developmental dysplasia of the hip treated by closed reduction: a review of 385 patients and meta-analysis

Abstract

This study aimed to investigate the effects of preliminary traction on the rate of failure of reduction and the incidence of femoral head avascular necrosis (AVN) in patients with late-detected developmental dysplasia of the hip treated by closed reduction. A total of 385 patients (440 hips) treated by closed reduction satisfied the inclusion criteria. Patients were divided in two groups according to treatment modality: a traction group (276 patients) and a no-traction group (109 patients). Tönnis grade, rate of failure reduction, AVN rate, acetabular index, center-edge angle of Wiberg, and Severin’s radiographic grade were assessed on plain radiographs, and the results were compared between the two groups of patients. In addition, a meta-analysis was performed based on the existing comparative studies to further evaluate the effect of traction on the incidence of AVN. Tönnis grade in the traction group was significantly higher than in the no-traction group (P = 0.021). The overall rate of failure reduction was 8.2%; no significant difference was found between the traction (9.2%) and no-traction groups (5.6%) (P = 0.203). The rates of failure reduction were similar in all Tönnis grades, regardless of treatment modality (P > 0.05). The rate of AVN in the traction group (14%) was similar to that of the no-traction group (14.5%; P = 0.881). Moreover, the rates of AVN were similar in all Tönnis grades, regardless of treatment modality (P > 0.05). The meta-analysis did not identify any significant difference in the AVN rate whether preliminary traction was used or not (odds ratio = 0.76, P = 0.32). At the last follow-up visit, the two groups of patients had comparable acetabular indices, center-edge angles, and Severin’s radiographic grades (P > 0.05). In conclusion, preliminary traction does not decrease the failure of reduction and the incidence of AVN in developmental dysplasia of the hip treated by closed reduction between 6 and 24 months of age.

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

“…The authors concluded that the Petit-Morel method was the treatment of choice for children aged between 6 months and 3 years who were affected by idiopathic DDH. On the contrary, other authors in three different comparative studies that included a large series of dislocated hips reported that preliminary traction (overhead or longitudinal) did not decrease the failure of reduction or the incidence of AVN [12,13,19]. Schur et al [33] even reported an increased risk of AVN when prereduction traction was used in a series of 70 children (82 hips).…”

“…The use of preliminary traction to facilitate closed reduction or to decrease the risk of avascular necrosis (AVN) is still debated [11][12][13]. In the 1980s, some authors questioned the role of preliminary traction in the treatment of congenital dislocation of the hip (CDH) and suspended its use, reporting satisfactory results in patients treated for CDH without preliminary traction, with a low incidence of AVN [14,15].…”

Clinical Efficacy and Safety of Ibuprofen plus Traction, Reposition, and Hip Spica Cast in the Treatment of Developmental Dysplasia of the Hip

“…Children with congenital dysplasia benefit from early diagnosis and reasonable treatment to achieve a favorable prognosis [ 17 , 18 ], but there are still some cases with delayed diagnosis or poor conservative treatment efficacy that require surgical treatment. Surgical treatment is mainly to restore the concentric relationship between the femoral head and the acetabulum, whilst avoiding femoral head necrosis and reoperation [ 19 , 20 ]. Traction + reposition + hip spica cast is a common clinical treatment for DDH.…”

Does the size of the femoral head correlate with the incidence of avascular necrosis of the proximal femoral epiphysis in children with developmental dysplasia of the hip treated by closed reduction?

“…However, follow-up time is enough to make sure as to whether AVN has occurred or not, as reported by previously published studies. 1,5,6,16 The correlation coefficient between the size of femoral head and incidence of AVN is relatively weak (r = -0.287); therefore, further studies with larger number of patients are needed to evaluate the effects of the size of femoral head on the incidence of AVN.…”