Patient's question:
The little boy is now 5 and a half years old. When he was three and a half, it was discovered that if he engaged in a lot of exercise or walked a lot, he would have a slight limp. Sometimes he would complain of pain. Because he is currently abroad, he was diagnosed with avascular necrosis of the femoral head.Doctor's answer:
1 year of age or less, use the Pavlik harness method. At 8-9 weeks postpartum, if hip joint subluxation or dislocation is detected, the Pavlik harness can be used for 6-9 months. It only restricts hip joint extension, while other activities remain unrestricted. Except for cases with internal obstacles to reduction, the majority of children can achieve successful reduction treatment without the risk of avascular necrosis of the femoral head. Alternative methods include the use of a onesie sock and abduction swaddling bandages, 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 can be adopted. Reduction method: Under general anesthesia, the child lies supine with the affected hip and knee each 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 can hinder femoral head development and cause ischemic changes, pediatric surgery in both domestic and international settings now avoids frog-leg in favor of the "human figure," which allows abduction of the hip joint to about 80° and slight flexion of the knee. After applying the, the child is permitted to bear weight on the cast.
4 years and older: At this stage, the degree of dislocation is more severe, and secondary changes in bone and soft tissues are also more pronounced, making manual reduction difficult to achieve. Surgical intervention should be adopted. The Salter pelvic osteotomy is performed. If the anteversion angle of the femoral neck exceeds 45°, additional femoral rotation osteotomy should be added.