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Home traction in the management of congenital dislocation of the hip

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Summary

A retrospective review of sixty children with seventy-eight congenitally dislocated hips who had pre-reduction traction at home was undertaken to assess the effectiveness of the traction and the incidence of severe complications, with specific reference to the incidence and severity of avascular necrosis. Thirty other children with forty-two congenitally dislocated hips who had pre-reduction traction while in the hospital were used as controls. Traction failed to radiologically improve the position of the head in relation to the acetabulum in two hips in each group. The incidence of avascular necrosis was 17.9 percent in hips treated at home and 23.8 percent in hips treated in the hospital. The hospital control group demonstrated higher incidences of the more severe types of necrosis. Traction at home was found to be an advantageous alternative to traction in the hospital, in that it is safe, effective, and less costly; however, it must be stressed that proper patient selection and careful monitoring of the program are required.

Zusammenfassung

Eine retrospektive Studie wurde an 60 Kindern mit einer congenitalen Hüftluxation an 78 Hüftgelenken durchgeführt, bei denen die Extensions-Einrenkungsbehandlung zu Hause durchgeführt wurde. Die Wirksamkeit der Extension und die Häufigkeit schwerer Komplikationen sollte ermittelt werden, insbesondere die Häufigkeit und die Ausdehnung avaskulärer Nekrosen. 30 andere Kinder mit 42 congenital luxierten Hüftgelenken, bei denen die Extensions-Einrenkungsbehandlung im Krankenhaus durchgeführt wurde, dienten als Kontrollgruppe. Bei jeweils 2 Hüftgelenken in jeder Gruppe gelang es mit der Extension nicht, die Stellung des Hüftkopfes gegenüber dem Acetabulum zu verbessern. Die Häufigkeit der avasculären Nekrosen betrug bei den zu Hause behandelten Hüften 17,9% und bei den im Krankenhaus behandelten 23,8%. Bei der letztgenannten Gruppe waren auch die schweren Nekroseformen häufiger. Es hat sich herausgestellt, daß die Extensionsbehandlung zu Hause eine vorteilhafte Alternative zu der Behandlung im Krankenhaus darstellt, weil sie sicher, wirksam und kostensparend ist. Es muß jedoch betont werden, daß eine richtige Auswahl der Patienten und eine sorgfältige Überwachung des Behandlungsprogramms erforderlich sind.

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Correspondence to G. D. MacEwen.

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Voutsinas, S.A., MacEwen, G.D. & Boos, M.L. Home traction in the management of congenital dislocation of the hip. Arch. Orth. Traum. Surg. 102, 135–140 (1984). https://doi.org/10.1007/BF00575221

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Keywords

  • Avascular Necrosis
  • Careful Monitoring
  • Severe Type
  • Proper Patient
  • Hospital Control