Use of the Tübingen splint for the initial management of severely dysplastic and unstable hips in newborns with DDH: an alternative to Fettweis plaster and Pavlik harness

Kubo, Hannes; Pilge, Hakan; Weimann-Stahlschmidt, K.; Stefanovska, K.; Westhoff, Bettina; Krauspe, R.

doi:10.1007/s00402-017-2827-3

Cited by 25 publications

(23 citation statements)

References 13 publications

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“…However, infants with these risk factors should be screened for DDH. In our study, the success rate of treating DDH of Graf type IIc and above before the age of 6 months using the Tübingen splint was 83.7%, which was comparable with previous studies (Table 5) [7,16,17,19,21]. Patient age at treatment initiation may influence treatment efficacy.…”

Section: Discussionsupporting

confidence: 89%

“…A previous multicenter prospective study showed a high treatment failure rate in patients with Graf type IV DDH [22]. The treatment failure rate for Graf IV DDH was 33.3% (4/12) and 78.6% (11/14) in two previous studies [7,21]. In our study, the treatment failure rate in the Graf type IV hips was significantly higher than other Graf types (70.3% vs 7.2%, p < 0.001).…”

Section: Discussionsupporting

confidence: 42%

“…The Pavlik harness is the most commonly used method for the treatment of DDH in infants aged 0-6 months [6]. It allows a certain movement range of the hip and the knee while maintaining the hip joint in flexion and abduction, which is thought to promote the development of the femoral head and the acetabulum [7]. The reported success rate of reduction in DDH using the Pavlik harness is around 70% [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 42%

Section: Introductionmentioning

confidence: 99%

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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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“…15-18 Under certain conditions unstable hips can be successfully treated with the Tübingen splint. 19,20 .All therapies are based on the principle: 1) reduction; 2) retention; and 3) maturation.…”

Section: Introductionmentioning

confidence: 99%

Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf

Kubo

Pilge

et al. 2018

Journal of Children's Orthopaedics

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PurposeIn this study the course of unstable hips after successful treatment with Fettweis plaster of Paris (POP) is examined. Special focus will be given to age at beginning of treatment and initial hip type.MethodsThe development of 93 unstable hips treated between November 2001 and April 2015 was examined. Inclusion criteria were: 1) unstable hips with successful treatment with Fettweis POP; 2) presence of two pelvic radiographs (12 to 24 months and 24 to 48 months). We analyzed: 1) the initial ultrasound hip type according to Graf; 2) the average age at first and second radiograph; 3) the Tönnis classification: normal findings (< 1 SD), slightly (1 SD to 2 SD) and severely dysplastic hips (> 2 SD).ResultsIn all, there were 14 hips type D, 41 hips type III and 38 hips type IV. Mean age of the first radiograph was 13.9 months and of the second 28.5 months. The first radiograph showed: (< 1 SD): 36, (1 SD to 2 SD): 34, (> 2 SD): 23 hips, the second radiograph: (< 1 SD): 33, (1 SD to 2 SD): 19, (> 2 SD): 30 hips. With subdivision at the start of treatment at age eight or fewer weeks 2/16 hips (12.5%) and with initiation of the treatment more than eight weeks 22/77 (26.0%) deteriorated. During the course between first and second radiograph a total of 35.7% of initial hip type D, 19.5% of type III and 23.7% of type IV deteriorated.ConclusionRadiograph controls after treatment with Fettweis POP show poorer outcome after delaying the start of treatment more than 8 weeks. These findings were independent of the initial ultrasound hip type. Regular radiograph controls of all hip types treated for unstable hips are justified to detect residual dysplasia.Level of evidence:IV

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“…Nevertheless, all of them – Tübingen splint, Fettweis plaster and Pavlik harness – show similar good success rates in treating unstable hip joints. 23 24 …”

Section: Discussionmentioning

confidence: 99%

Treatment of unstable hips with the Tübingen splint in early postnatal period: Radiological mid-term results of 75 hips with mean follow-up of 5.5 years

Kubo

Oezel

Latz

et al. 2020

Journal of Children's Orthopaedics

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Purpose For treatment of unstable hips, the Tübingen splint is a treatment option. After the initial treatment, regular radiological follow-up examinations are recommended but there is a lack of long-term outcome studies. Therefore, the further development of unstable hips treated with the Tübingen splint were evaluated. Methods From 2004 to 2015 116 patients with 161 unstable hips treated with the Tübingen splint were evaluated. Inclusion criteria were: 1) successfully treated unstable hip (type D, III and IV); 2) pelvic radiographs at the age of one to ≤ two, two to ≤ four and four to ≤ eight years. The acetabular index (ACI) of all and the centre-edge angle (CEA) of the third radiograph were measured and classified according to the Tönnis classification. Results A total of 53 patients with 75 unstable hips (type D 34 (45.3%), III 33 (44.0%), IV 8 (10.7%)) were included. In comparison of the first, second and third radiograph, an increase of normal findings was seen in 31 (41.3%) to 53 (70.7%) and 60 (80.0%) hips, respectively. However, a decrease of slightly dysplastic hips from 31 (41.3%) to 19 (25.3%) and 14 (18.7%) respectively and severely dysplastic hips from 13 (17.3%) to three (4.0%) and one (1.3%) hip respectively was detected. In comparison of first to second radiograph, 32 hips improved and five hips deteriorated and of second to third radiograph 16 hips improved and six hips deteriorated. The Tönnis classification of ACI compared with CEA showed no significant differences (p = 0.442). Conclusion This study shows a good development of unstable hips treated with the Tübingen splint with mean follow-up 5.5 years. Nevertheless, unexpected deteriorations could be identified. The CEA is an alternative to the ACI. Level of evidence IV

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Use of the Tübingen splint for the initial management of severely dysplastic and unstable hips in newborns with DDH: an alternative to Fettweis plaster and Pavlik harness

Abstract: Our data show, that successful treatment of unstable hips in neonates with the Tübingen splint is a comparably successful treatment modality relative to the Pavlik harness and Fettweis plaster.

Cited by 25 publications

References 13 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

Poorer radiological outcome after delayed diagnosis and treatment in human position in Fettweis plaster cast in 93 unstable hip joints type D, III and IV according to Graf

Treatment of unstable hips with the Tübingen splint in early postnatal period: Radiological mid-term results of 75 hips with mean follow-up of 5.5 years

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