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[Translated article] Early recovery of acetabular index in ddh as good prognosis factor after closed reduction and spica cast treatment

Year: 2025

Type: article

Abstract: INTRODUCTION: Early diagnosis of DDH, ultrasonography and treatment with Pavlik arnais have provided an improvement of the results. However, always appear children more than 3 months until 24-months old with late diagnosis or failure with Pavlik treatment requiring closed reduction and spica cast treatment as standard management. MATERIAL AND METHOD: The authors reviewed retrospectively DDH cases treated all patients treated with spica cast in human position during 3 months. The minimum follow-up was 5 years. It was considered good result when DDH reduced, remained stable, concentric, without AVN and not required surgery for sequels. All demographics, clinical and radiological parameters were statistically analyzed. RESULTS: Of a total 152 hips were treated, 24 (15.8%) required surgery. In 6 cases (4%) was observed AVN. According IHDI/Tönnis displacement severity, types I and II were success treated in 98.9% and types III/IV in 64%. As bad prognosis factors were identified Ortolani test (+), alfa angle minor than 44°, acetabular index higher than 44° or IHDI/Tönnis types III/IV and factors for a good prognosis types I/II and the early recovery of the acetabular index more than 10° after 5 months of treatment. The age and early treatment of the patients was only important for the hips type III/IV (64 hips), the mean age of patients treated successfully was 5.1 months (64%), comparing with 8.8 months of the surgery group (36%). The incidence of AVN was 4% (6 cases) and in all cases the nucleus of ossification was not present in the X-ray pre-treatment. We cannot find relationship between AVN with previous skin traction, adductor tenotomy or severity of displacement. CONCLUSIONS: Conservative management of DDH with spica cast provide excellent results in almost all cases in types I and II hips (98.9%) and in 64% of types III/IV. An improvement of the acetabular index more than 10°, 5 months after the treatment is the best prognosis factor for a good result.

Source: Revista Española de Cirugía Ortopédica y Traumatología

DOI: 10.1016/j.recot.2025.11.006

Authors: P. González-Herranz, N. Penelas-Abelleira, M.L. Rodríguez-Rodríguez, M. Goday-Etxebarria

Institution: Complexo Hospitalario Universitario A Coruña

Language: English

Topic: Hip disorders and treatments

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,430