Patient's question:
Detailed medical condition and consultation purpose: Congenital hip dysplasia with hip joint dislocation. Searched for a good hospital in Beijing for treatment. First follow-up question: Can you tell me the name of the hospital? It is famous for orthopedics.Doctor's answer:
1 year or younger, use the Pavlik harness method. At 8-9 weeks postpartum, if hip dislocation or subluxation is detected, the Pavlik harness can be used for 6-9 months. It only restricts hip extension, while other activities remain unrestricted. Except for cases with internal obstacles to reduction, most children can achieve successful reduction without the risk of avascular necrosis of the femoral head. Alternative methods include the use of a onesie suit and abduction swaddling, which should be maintained for more than 4 months.1-3 years old: For some mild cases, the Pavlik harness method can still be used for treatment. If reduction is not achieved after 4-6 weeks of use, manual reduction with (plaster immobilization) can be considered.
Reduction method: Under general anesthesia, the child lies supine with the hip and knee of the affected side flexed at 90°. Traction is applied along the longitudinal axis of the thigh while compressing the greater trochanter to guide the femoral head back into the acetabulum. After successful reduction, since frog-leg (frog-leg cast) can hinder femoral head development and cause ischemic changes, it is no longer used in pediatric surgery, both domestically and internationally. Instead, the "human-figure" (human-figure cast) is adopted, which allows the hip joint to be slightly abducted (around 80°) with minimal knee flexion, and permits the child to bear weight on the cast.
4 years or older: At this stage, the degree of dislocation is more severe, and secondary changes in bone and soft tissues are also more pronounced. Manual reduction is often unsuccessful, and surgical intervention should be considered. The Salter pelvic osteotomy is performed. If the anteversion angle of the femoral neck exceeds 45°, additional femoral rotational osteotomy is recommended.