Abstract
Introduction: The Pavlik harness is widely used in the management of developmental dysplasia of the hip and its efficacy in the treatment of instability and acetabular dysplasia is well established. There are some hips which although reducible consistently fail to stabilise in a harness irrespective of the age of application. We report three cases in which through altering the method of application of the harness, stability and subsequent normal development was achieved.
Method: Three patients age one week, six weeks and twelve weeks failed to stabilise in a harness applied in the conventional fashion. By rerouting the posterior “abduction strap” in front of the anterior “flexion” strap and attaching it as usual distally we observed improved abduction and more restriction of movement such that the unstable hip was held reduced. Reduction was confirmed by anterior ultrasound. The harness was converted back to the conventional application at four weeks by which time all of the hips had stabilised clinically. It was retained for a further eight weeks.
Results: Significant dysplasia was evident in all three hips at presentation ( alpha angles 32, 48 and 34). At average follow up of 23 months all hips were concentrically reduced with no significant persisting dysplasia nor evidence of avascular necrosis.
Discussion: Early reduction and stabilisation of the femoral head in DDH is important if subsequent intervention is to be minimised and it has been suggested that the more rigid Von Rosen splint is more effective than the Pavlik in achieving this. Our early experience with this simple modification has been successful in treating three unstable hips which would otherwise have failed splintage in our hands. We recommend it as an option to consider in the unstable hip, in conjunction with anterior ultrasound to confirm that reduction has been achieved from the outset.
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