Overhead Traction as a Treatment for Late Detected or Previously Failed DDH

Introduction and Objective:
The aim of this study was to evaluate the success of overhead traction as a tool for concentric reduction for late detected or previously failed treatment of DDH.

Materials and Methods:
Retrospective study of 61 otherwise healthy patients (74 hips), mean age 6.5 months (2.5 - 21). Inclusion criteria included: failed abduction treatment (37 patients), late detected (23 patients) and failed Pavlik and closed reduction under anaesthesia (1). Gradual skin overhead traction was used for a mean of 21 days (12-28), followed by in-traction anterior-posterior pelvic x-ray. When reduction achieved, divarication cast was applied in the clinic for 12 weeks, followed by abduction brace (Jordan) for another 12 weeks. Patients were monitored 6 months post reduction, and at ages 2, 4, 8 and 12 years. Initial Acetabular Index (AI) and last follow-up AI and migration percentage (MP) were measured using TraumaCad software.

Results:
Overhead traction achieved concentric reduction in 45 patients (74%). These hips needed no additional treatment during an average follow up of 4 years (1-8.5). In 16 patients, reduction was not achieved and they underwent arthrography, open adductor and iliopsoas release, closed reduction and Spica cast. 4 of these patients needed further surgical intervention. No difference was found between the successful and failed reduction patients in either age or duration of traction. There were however significantly more patients with bilateral involved hips in the failed group - 8/16 (50%) as compared to the successful group-5/45 (11%). Initial AI was more severe in the failed group-40.5 degrees compared to 38.6 degrees in the successful group (p=0.04).

Conclusions:
Overhead traction is a reliable tool to help reduce congenital DDH in either late detected or previously failed other conservative treatment methods.