Pavlik harness and Frejka pillow: compliance affects results of outpatient treatment
- 22 Downloads
Purpose of the study
Outpatient treatment of hip dysplasia in newborns has excellent results. A combination of general screening with early treatment with a functional abduction device works well. Treatment with the Frejka pillow and the Pavlik harness is frequently used in our region. The aim of the study is to compare efficiency and treatment duration, related to the brace used, and to prove that the choice of an abduction device implies parental compliance with the treatment protocol.
Materials and methods
Data of 286 treated children were analyzed. The diagnosis was made in the first weeks of life by clinical and sonographic examinations during general screening. The choice of treatment device was expert dependent and was involved by many variables. The experience, type of clinical finding and sonographic pathology according to Graf, availability of a treating facility, and the potential cooperation of individual parents were major parameters. The Frejka pillow was used to treat 145 children and the Pavlik harness was used in 137 children. The treatment duration and percentage of infants lost from follow-up in relation to the device used was documented.
The success rate of outpatient treatment was 98.6%. In six patients, the type of device had to be changed during the treatment period. Physiological sonographic findings were achieved in all hips by the end of the treatment. The Frejka pillow was used as the preferred device in milder stable dysplastic hips, while unstable and decentered hips were treated more frequently with the Pavlik harness. Treatment lasted, on average, 95 days and 119 days in the Frejka and in the Pavlik group, respectively; there was no statistical significance in treatment duration of comparable sonographic pathologies. We observed statistically greater parental non-compliance with the treatment protocol in the Pavlik harness group (p = 0.0279; OR 2.7; 95% CI 1.07; 8.5).
Neither of the abduction devices was inferior with regard to treatment efficiency. We found that parental cooperation was an important factor during screening and treatment. The treatment decision and the choice of the brace must be made with full consent of the parents, keeping in mind that comfort during the nursing care may have a significant influence on compliance with the treatment protocol.
KeywordsDDH treatment Pavlik harness Frejka pillow Hip sonography Non-compliance
There is no funding source.
Compliance with ethical standards
Conflict of interest
Michal Zídka and Valér Džupa declare that they have no conflict of interest and had gained no benefits concerning the study.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 1.Frejka B (1941) Prävention den angeborenen Hüftgelenkluxation durch das Abduktionspolster. Wien Med Wschr 25:523Google Scholar
- 4.Dungl P (1996) Methodological instruction for the prevention and treatment of hip dysplasias (in Czech). Acta Chir Orthop Traumatol Cech 63:60–63Google Scholar
- 5.Graf R (1980) The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch Orthop 97:117–133Google Scholar
- 8.Dorguel H, Atalar H, Yavuz O, Sayli U (2008) Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip. Inter Orthop 3:415–419Google Scholar
- 9.Blom HC, Heldaas O, Manoharan P, Asdersen BD, a SØia L (2005) Ultrasound screening for hip dysplasia in newborns and treatment with Frejka pillow (In Norwegian). Tidsskrift For Den Norske Laegeforening: Tidsskrift For Praktisk Medicin, Ny Raekke 125:1998–2001Google Scholar
- 12.Tegnander A, Holen KJ, Anda S, Terjesen T (2001) Good results after treatment with the Frejka pillow for hip dysplasia in newborns: a 3-year to 6-year follow-up study. J Pediatr Orthop Part B 10:173–179Google Scholar
- 14.Czubak J, Piontek T, Niciejewski K, Mangowski P, Majek M, PŁoczak M (2004) Retrospective analysis of the non-surgical treatment of developmental dysplasia of the hip using Pavlik harness and Frejka pillow: comparison of both methods. Ortopedia, Traumatologia, Rehabilitacja 6:9–13Google Scholar
- 17.Bin K, Laville J-M, Salmeron F (2014) Developmental dysplasia of the hip in neonates. Orthopaedics 100:357–361Google Scholar
- 18.Pach M, Kamínek P, Mikulík J (2008) Wagner stockings for the treatment of developmental dysplasia of the hip diagnosed early by general screening (In Czech). Acta Chir Orthop Traumatol Cech 75:277–281Google Scholar
- 22.Pavlík A (1955) The issue of functional treatment of congenital hip dislocation in infants (In Czech). Acta Chir Othop Traumatol Cech 22:33–40Google Scholar
- 23.Mubarak SJ, Bialik V (2003) Pavlik: the man and his method. J Pediatr Orthop 23:342–346Google Scholar