International Orthopaedics

, Volume 43, Issue 5, pp 1135–1141 | Cite as

Clinical study of anterior hip ultrasound (van Douveren’s method)-assisted Pavlik harness

  • Yihua Ge
  • Zhigang Wang
  • Yunlan XuEmail author
Original Paper



To investigate the use of anterior hip ultrasound (van Douveren’s method)-assisted Pavlik harness in developmental dysplasia of the hip (DDH).


Weekly anterior hip ultrasound scanning was performed in children with fixed Pavlik harness to detect whether hip reduction was achieved with the help of harness (the superior ramus of the pubis, the acetabulum, the femoral head, and the femoral neck being depicted in one plane indicated concentric reduction of the hip), and the stability of the reduction was checked by ultrasonography.


A total of 39 child patients and 51 dysplastic hips were successfully detected by anterior ultrasound, and stable reduction was achieved in 37 hips (15 Graf type D and 22 type III) right after the help of Pavlik harness, in seven hips (6 type III and 1 type IV) two weeks after the help of Pavlik harness; the remaining seven hips (2 type III and 5 type IV) failed to reach stable reduction after two weeks.


The anterior hip ultrasound (van Douveren’s method) can be used to detect the reduction and stability of hip after Pavlik harness treatment in children with DDH. The majority of Graf type D and III hips can achieve a stable concentric reduction right after the help of Pavlik harness, while severely dislocated type IV hips have a low success rate for harness treatment, and abandonment of harness therapy should be considered in early stage.


Ultrasonography Anterior ultrasound Children Developmental dysplasia of the hip 


Funding information

This work was supported by the Shanghai Science and Technology Commission (no. 16411971600).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethical Committee of the Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine.

Informed consent

Informed consent was obtained from all parents of children included in the study.


  1. 1.
    Gulati V, Eseonu K, Sayani J, Ismail N, Uzoigwe C, Choudhury MZ, Gulati P, Aqil A, Tibrewal S (2013) Developmental dysplasia of the hip in the newborn: a systematic review. World J Orthopedics 4(2):32–41CrossRefGoogle Scholar
  2. 2.
    Graf R (1984) Fundamentals of sonographic diagnosis of infant hip dysplasia. J Pediatr Orthop 4(6):735–740CrossRefGoogle Scholar
  3. 3.
    Graf R (2017) Hip sonography: background; technique and common mistakes; results; debate and politics; challenges. Hip Int: J Clinical Experimental Res Hip Pathology Therapy 27(3):215–219CrossRefGoogle Scholar
  4. 4.
    Wientroub S, Grill F (2000) Ultrasonography in developmental dysplasia of the hip. The Journal of bone and joint surgery American volume 82-a (7):1004-1018Google Scholar
  5. 5.
    van Douveren FQ, Pruijs HE, Sakkers RJ, Nievelstein RA, Beek FJ (2003) Ultrasound in the management of the position of the femoral head during treatment in a spica cast after reduction of hip dislocation in developmental dysplasia of the hip. J Bone Joint Surgery British Volume 85(1):117–120CrossRefGoogle Scholar
  6. 6.
    Woodacre T, Carlile GS, Cox PJ (2015) The “ischial limb”: a landmark on anterior ultrasound scanning used to assess reduction in developmental dysplasia of the hip. J Pediatr Orthop 35(1):62–68CrossRefGoogle Scholar
  7. 7.
    Guille JT, Pizzutillo PD, MacEwen GD (2000) Development dysplasia of the hip from birth to six months. J Am Academy Orthopaedic Surgeons 8(4):232–242CrossRefGoogle Scholar
  8. 8.
    Kolb A, Benca E, Willegger M, Puchner SE, Windhager R, Chiari C (2017) Measurement considerations on examiner-dependent factors in the ultrasound assessment of developmental dysplasia of the hip. Int Orthop 41(6):1245–1250CrossRefGoogle Scholar
  9. 9.
    Kolb A, Schweiger N, Mailath-Pokorny M, Kaider A, Hobusch G, Chiari C, Windhager R (2016) Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors. Int Orthop 40(1):1–5CrossRefGoogle Scholar
  10. 10.
    Upasani VV, Bomar JD, Matheney TH, Sankar WN, Mulpuri K, Price CT, Moseley CF, Kelley SP, Narayanan U, Clarke NM, Wedge JH, Castaneda P, Kasser JR, Foster BK, Herrera-Soto JA, Cundy PJ, Williams N, Mubarak SJ (2016) Evaluation of brace treatment for infant hip dislocation in a prospective cohort: defining the success rate and variables associated with failure. J Bone Joint Surg Am 98(14):1215–1221CrossRefGoogle Scholar
  11. 11.
    Novais EN, Kestel LA, Carry PM, Meyers ML (2016) Higher Pavlik harness treatment failure is seen in Graf type IV Ortolani-positive hips in males. Clin Orthop Relat Res 474(8):1847–1854CrossRefGoogle Scholar
  12. 12.
    Omeroglu H, Kose N, Akceylan A (2016) Success of Pavlik harness treatment decreases in patients >/= 4 months and in ultrasonographically dislocated hips in developmental dysplasia of the hip. Clin Orthop Relat Res 474(5):1146–1152CrossRefGoogle Scholar
  13. 13.
    Gornitzky AL, Schaeffer EK, Price CT, Sankar WN (2016) Pavlik harness disease revisited: does prolonged treatment of a dislocated hip in a harness adversely affect the alpha angle? Journal of pediatric orthopedicsGoogle Scholar
  14. 14.
    Suzuki K, Futami (1992) Ultrasonography in congenital dislocation of the hip. J Pediatr Orthop 12(3):416CrossRefGoogle Scholar
  15. 15.
    Suzuki S, Kasahara Y, Futami T, Ushikubo S, Tsuchiya T (1991) Ultrasonography in congenital dislocation of the hip. Simultaneous imaging of both hips from in front. J Bone Joint Surgery British Volume 73(6):879–883CrossRefGoogle Scholar
  16. 16.
    Fukiage K, Futami T, Ogi Y, Harada Y, Shimozono F, Kashiwagi N, Takase T, Suzuki S (2015) Ultrasound-guided gradual reduction using flexion and abduction continuous traction for developmental dysplasia of the hip: a new method of treatment. The bone & joint journal 97-b (3):405-411Google Scholar
  17. 17.
    Keller MS, Weiss AA (1988) Sonographic guidance for infant hip reduction under anesthesia. Pediatr Radiol 18(2):174–175CrossRefGoogle Scholar
  18. 18.
    Smith BG, Kasser JR, Hey LA, Jaramillo D, Millis MB (1997) Postreduction computed tomography in developmental dislocation of the hip: part I: analysis of measurement reliability. J Pediatr Orthop 17(5):626–630CrossRefGoogle Scholar
  19. 19.
    Beek FJ, Nievelstein RJ, Pruijs HE, de Jong PA, Sakkers RJ (2010) Transinguinal sonographic determination of the position of the femoral head after reposition and follow-up in a spica cast. Pediatr Radiol 40(11):1794–1799CrossRefGoogle Scholar
  20. 20.
    Carlile GS, Woodacre T, Cox PJ (2014) Verification of hip reduction using anterior ultrasound scanning during Pavlik harness treatment of developmental dysplasia of the hip. J Orthop 11(4):174–179CrossRefGoogle Scholar
  21. 21.
    Suzuki S (1994) Reduction of CDH by the Pavlik harness. Spontaneous reduction observed by ultrasound. J Bone Joint Surgery British Volume 76(3):460–462CrossRefGoogle Scholar
  22. 22.
    Eberhardt O, Zieger M, Langendoerfer M, Wirth T, Fernandez FF (2009) Determination of hip reduction in spica cast treatment for DDH: a comparison of radiography and ultrasound. J Child Orthop 3(4):313–318CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedics, Shanghai Children’s Medical CenterShanghai Jiao Tong University School of MedicineShanghai CityPeople’s Republic of China

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