Treatment of congenital dislocation of the hip by the Pavlik harness

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Title
Treatment of congenital dislocation of the hip by the Pavlik harness.
Mechanism of reduction and usage.
Author(s)
Iwasaki, Katsuro
Citation
J Bone Joint Surg Am. 1983; 65(6) pp.760-767.
Issue Date
1983-07
URL
http://hdl.handle.net/10069/22324
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Treatment of congenital dislocation of the hip by the Pavlik harness.
Mechanism of reduction and usage
K Iwasaki
J Bone Joint Surg Am. 1983;65:760-767.
This information is current as of November 5, 2009
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The Journal of Bone and Joint Surgery
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www.jbjs.org
Copyright
983
by
Treatment
The
Journal
of
Bone
and
Surgery.
Joint
of Congenital
Incorporated
Dislocation
of the Hip by the Pavlik
MECHANISM
BY
From
the
The
of complete
in a series
Department
REDUCTION
IWASAKI,
of Orthopaedic
M.D.*,
Surgery,
AND
University
femur,
a false
the
outpatient
Nagasaki
was
28 per cent.
Application
of the
Pavlik
harthe
the
by
movement
acetabulum
the
is
femoral
head
anteriorly
abduction
of the hip,
possible
because
of stretching
of the
by the weight
of the lower
extremity.
tion is obtained
by forced
abduction
danger
of avascular
necrosis
and
this
is considered
femoral
of this
of Medicine,
subluxation,
tion,
from
acetabular
between
(Table
out
patients6’T’t0t2,
allegedly
used
properly24”2.
seen
at my clinic
controlled
peutic
results
because
the
1976,
therefore,
Since
have
adjustment
thus
been
of
after
its
harness
hospitalized
the
Pavlik
obtained
application
was
the
and
the
harness.
were
considerably
has
two
groups
treated
on an outpatient
basis
The mechanism
of reduction
and
of
the other,
as inpatients.
the dislocation
using
harness
was
also
studied.
Materials
and
basis
at the
of patients,
one
A dislocation
*
Department
of Medicine,
760
7-1,
was
of Orthopaedic
Sakamoto-Machi,
diagnosed
and
made
with
a
one
hips
with
the
Pavlik
criteria
of avascular
of appearance
that
were
necrosis
clinical
signs:
failure
University
School
head for one year or longer
growth
of an existing
ossific
Japan.
showed
in all of these
a
patients,
of the femoral
head in
followed
for more than
years.
Forty
patients
were lost to follow-up
after
one
and seventy-three,
after
five years.
Most
of them
moved
to other cities without
leaving
a new address.
nosis
City,
were
anteroposterior
the hip in extension,
necrosis
who were
Nagasaki
Nagasaki
examinations
a neutral
harness
by these
Surgery,
clinical
When
a week
was re-
year, and the incidence
of anatomical
healing
in 153
of 13 1 patients
who were followed
for more than five
The
Methods
of treatment
and averaged
four
as soon as the diag-
that were made once
After the dislocation
a month.
the incidence
of avascular
193 hips of 164 patients
different
on an outpatient
Pavlik
treatment
thera-
from those in patients
treated
clinic.
In this report
I compare
excluded
concentric
position
of the femoral
head the hip was considered
stable.
After four to eight months,
when the shallow acetabulum
was seen to have
improved
roentgenographically,
the harness
was removed.
I tried to determine
the rate of reduction
after initial
not
staff
once
roentgenogram,
patients
The
disloca-
were
at the beginning
as well as by roentgenograms
until reduction
was achieved.
method.
roentgenographic
harness
teratological
one and seven
months
I). For the outpatients,
carried
of the
of Orthopaedic
Surgery,
Medicine.
Patients
with
arthrogryposis
this study.
The ages of the patients
duced,
adjustment
of the affected
extremity,
or
confirmed
by roentgenograms
of the proximal
end of the
or
is
the
City
dysplasia,
myelodysplasia,
mostly
carried
out at home
by the child’s
mother,
the
question
always
arises
as to how well the harness
is being
used.
Since
the report
by PavIlk,
many
studies
of this
method
of treatment
have been done.
Reduction
has been
reported
to be unsuccessful
in 10 to 20 per cent of the
Since
Nagasaki
nosis was made the Pavlik
harness
was applied
and the patient was checked
at intervals
of three to seven
days.
Reduction
and stability
were evaluated
by clinical
signs such
as the absence
of limited
abduction
and of the click sign,
head.
dislocation
of the hip with
done on an outpatient
basis,
to be an advantage
School
basis at the Department
University
School
of
ranged
months
adductor
muscles
When
the reducthere is a greater
of the
Treatment
of congenital
the Pavlik
harness
is generally
into
which
JAPAN
interruption
of the Shenton
line, or the presence
of
acetabulum.
Between
1966 and the first half of 1976,
240 completely
dislocated
hips of 204 patients
were treated
on an
ness
allowed
reduction
of the hip
by shifting
femoral
head
first
to the
posterior
part
of
acetabulum
through
fiexion
of the hip,
followed
of the
through
CITY,
limited
abduction,
shortening
a positive
click sign. It was
showing
lateral
displacement
or an inpatient
basis.
The results
in the two groups
were compared.
For the children
treated
as outpatients
the incidence
of avascular
necrosis
of the femoral
head
was 7.2 per cent and for the group
treated
as inpatients
rate
USAGE
NAGASAKI
Nagasaki
Pavlik
harness
was used
in the
congenital
dislocation
of one or
of infants,
on either
an outpatient
ABSTRACT:
treatment
both hips
KATSURO
OF
Harness
of the
THE
year
had
used
in establishing
the
were
those
et al . : (1)
ossific
of Salter
nucleus
diag-
of the femoral
after reduction,
(2) failure
of
nucleus
for one year or longer
JOURNAL
OF BONE
AND
JOINT
SURGERY
TREATMENT
BY
THE
PAVLIK
TABLE
RESULTS
OF
TREATMENT
WITH
THE
I
PAvLIK
HARNESS
IN
of the Patients
at the Start
No.
of Treatment
(Days)
Hips
of
THE
No.
GROUP
Hips
Fob
wed for Five
Avascular
Necrosis
Reduction
Treated
OUTPATIENT
fo r One Year
Hips Foil owed
Age
761
HARNESS
Per
Cent
Total
No.
No.
Years
Anatomical
Healing
Per
Cent
Total
No.
No.
Per
Cent
31-60
29
24
82.7
22
3
20
18
90.0
61-90
53
43
81.1
43
4
9.3
38
32
84.3
13.6
91-120
73
67
91.1
63
4
6.3
46
40
87.0
121-150
43
37
86.0
37
2
5.4
27
22
81.5
151-180
30
23
76.6
0
181-210
12
Total
Hips
Patients
7
240
204
201
179
21
0
15
11
73.4
58.3
7
1
14.2
7
4
57.2
83.7
193
164
14
7.2
153
131
127
83.0
after reduction,
(3) broadening
of the femoral
neck during
the year after reduction
,
(4) increased
roentgenographic
density
of the femoral
head
followed
by the roentgenographic
appearance
of fragmentation,
and (5) residual
de-
group
3 consisted
of eleven
hips (ten patients)
that were
treated
similarly
to those in subgroup
2, with the only difference
being
that at the beginning
of treatment
the patients
were between
six and twelve
months
old (average,
formity
plana,
eight
of the femoral
head and neck (coxa
coxa vara,
or a short
broad
femoral
reossification
was
patients
who
cally or severe
ographically,
twenty-nine
seen
teen
half of 1976
hips)
were
In the latter
had
severe
adductor
infants
(thirty-one
contracture
hips)
at our hospital
during
that period,
hips)
were treated
as inpatients.
and
(thirty-seven
as inpatients.
After application
were
made
of
dm1-
head roentgenThus,
of the
dislocated
who
1978
of the
dislocated
harness
to lie supine,
and
the
they
as
of
during
this
of forty inhips)
were
hospitalized
pa-
were
not allowed
to change
this position
even for nursing
or bathing.
Care
was taken to prevent
the diaper,
diaper-cover,
and clothing
from restricting
spontaneous
movements
of either
lower
extremity.
These
inpatients
were divided
into three
Subgroup
1 consisted
of fourteen
hips (eleven
which
the attempt
at reduction
in the outpatient
subgroups.
patients)
in
clinic had
been
unsuccessful.
The requirement
for hospitalization
was met when reduction
was not achieved
within
three to
four weeks after the application
of the harness
. At
the time
of admission
to the hospital
the ages of the eleven
patients
ranged
(Table
from two to six months
and averaged
4. 1 months
II). Subgroup
2 consisted
of twenty-five
hips in
twenty-three
was carried
patients
out and
The age range
to six months
VOL.
65-A,
NO.
for whom
no ambulatory
who were hospitalized
for
at the beginning
and averaged
6, JULY
1983
4.4
cation
of the
aise and poor
tion
The
of treatment
was
months
(Table
treatment
treatment.
from two
II). Sub-
(Table
II).
to clarify the process
harness,
appetite
of reduction
after
appli-
attention
was paid to signs of malin the infants
as well as to the posi-
and spontaneous
movements
of the lower extremities.
babies
were observed
clinically
and, when indicated,
records
(photographs
or eight-millimeter
movies)
were
ob-
tamed.
TABLE
AG ES
only eleven
(thirIn contrast,
during
signs.
Thus,
thirty-three
forty-five
months)
In order
were
1978 I tried to hospitalize
independent
of the severity
the clinical
or roentgenographic
latter time-period
of 1977 and
tients
to 1979,
forty-four
patreated
with the Pavlik
half of 1976 and during
displacement
of the femoral
or both,
were
hospitalized.
the period
between
1977
many
patients
as possible,
fants
treated
coxa
when
complete.
From
the latter
tients
(fifty dislocated
harness
as inpatients.
1979
magna,
neck)
Age
OF
HOSPITALIZED
No. of Subgroup-l
At Application
of Pavlik
Harness
II
PATIENTS
AT
Patients
At Admission
to the Hospital
STA
RT
OF
TREATMENT
No. of
Subgroup2 Patients
No. of
Subgroup3 Patients
(Days)
31-60
61-90
91-120
121-150
151-180
181-210
211-240
24 1-270
271-300
301-330
331-360
1
3
5
4
1
1
2
6
4
1
4
10
7
4
8
1
1
1
In each of the three subgroups
,
additional
studies
were
conducted
to determine
the necessity
of applying
traction
before
using
the Pavlik
harness,
the presence
of
complications
such as avascular
necrosis
and the acetabular dysplasia
at one year after reduction,
and the incidence
of anatomical
healing
at three years after reduction.
Results
Outpatients
Table I summarizes
the rates of success
with the Paylik harness
according
to the ages of these patients
at the
beginning
of treatment.
Reduction
was achieved
in about
85 per cent of the children
who were less than six months
762
KATSURO
IWASAKI
FIG.
In the
old,
than
per
but
six
left
the rate
months.
cent.
Avascular
of this
patient
treated
with
the
Pavlik
harness,
decreased
to 58 per cent in those
older
The over-all
rate of reduction
was 83.7
necrosis
fourteen
(7.2
were followed
genographic
first year
hip
of the
femoral
head
was
seen
in
193 hips ( 164 patients)
that
one year (Table
I). Roent-
per cent) of the
for more than
evidence
of the necrosis
appeared
after reduction
in all fourteen
hips.
within
the
Roentgeno-
graphic
changes
of avascular
necrosis
also occurred
in two
normal
contralateral
hips during
treatment
of the dislocated hip, but these changes
improved
within the next four
years.
The incidence
the younger
patients
Roentgenograms
followed
healing
of avascular
(Table
I).
of 153 hips
for more
in 127 hips
necrosis
was
higher
in
patients)
that
of acetabular
dysplasia
Hospitalized
After
limitation
was
In the fourthe degree
slight.
Patients
abduction.
On the
range
of abduction
days,
whereas
was
incomplete
of the harness,
these
of both hips, including
uninvolved
were
side,
restored
on the affected
and
scarcely
to normal
side
any
activity
in one
and
of abduction
spontaneous
movement
deepens
and muscle
tone decreases,
the angle of abduction
gradually
increases
until the baby awakens
and cries,
at
which
time the angle returns
to what it was before
the baby
to sleep.
Stretching
of the adductor
muscle
dislocation
remains
unreduced.
the
dislocation
is reduced.
In the
present
series,
re-
duction
within
was accomplished
in 75 per cent of the patients
seven days after application
of the harness.
As a rule,
after
the harness
was applied
no active
movement
of the lower
extremities
was observed,
except
for flexion
and extension
of the ankle joint,
until reduction
was accomplished
or even until a few weeks
later.
Meanthe
child
frequently
cried
TABLE
RESULTS
OF
probably
TREATMENT
FOR
THE
and
had
THE
PAVLIK
a poor
appetite.
Subgroupl
(14 hips)
III
WITH
HOSPITALIZED
Avascular
Necrosis*t
No.
Per
HARNESS
PATIENTS
Acetabular
Dysplasia*
Cent
No.
Per
Anatomical
Healingl
No.
Per
Cent
Cent
3
21
5
36
8
57
Subgroup
2
(25 hips)
10
40
3
12
15
60
Subgroup
3
(11 hips)
1
9
5
45
5
55
13
26
14
*
At one
t Includes
year
28
28
56
after reduction.
patients
with
both
acetabular
dysp1aia
and
avascular
necrosis.
or two
the range
of the abnormal
lower
extremity
occurred
as long as the
dislocation
remained
unreduced
(Fig.
1). Such restriction
of abduction,
which
gradually
disappears
in subsequent
weeks,
is most obvious
when the infant
is asleep.
As sleep
went
time
patients
had
incomplete
however,
the
.
Total
application
of movement
and
wakens
the baby because
of pain.
When
the baby again
falls asleep,
the angle of abduction
increases
and the baby
wakes
again.
This might
be repeated
several
times during
the night for several
nights
When
treatment
is successful
the restriction
of abduction
gradually
disappears,
at which
anatomical
of 83 per
two showed
no abnormality.
not have avascular
necrosis,
full
were
cent (Table
I). Deformity
of the femoral
head or acetabular
dysplasia,
or both,
persisted
in twenty-six
hips (twentytwo patients),
an incidence
of 17 per cent. Of the fourteen
hips that showed
avascular
necrosis,
eight had coxa plana
with acetabular
dysplasia,
four had slight deformity
of the
and
did
is not
while
(131
than
five years
revealed
in 109 patients,
an incidence
femoral
head,
teen hips that
1
abduction
:1:At three
years
after
reduction.
Coincident
with the reduction,
swelling
occasionally
appeared
in the area of the hip joint and persisted
for at least
one week
(Fig. 2), so that passive
movement
of the hip
joint caused
the baby to cry.
Spontaneous
movement
affected
side usually
appeared
of the lower extremity
about one week after
tion,
but this interval
Flexion
and extension
from
five to twenty
days.
knee appeared
first, with the
hip
joint
in the
ranged
of the
abducted
THE
position,
JOURNAL
and
OF BONE
was
followed
AND
JOINT
on the
reduc-
by ac-
SURGERY
TREATMENT
BY
THE
PAVLIK
2
FIG.
Swelling
appeared
in the area of the left hip joint
tive flexion
and extension
active
rotation
and adduction
dicating
month
spontaneous
movement
of the
of the hip. Then spontaneous
of the hip was observed,
in-
stabilization
of the joint.
It usually
for these motions
to become
normal
took about
(Fig. 3).
one
treatment
with
of twenty-five
less
than
six
months
treatment
at
old and who
were
hospitalized
(subgroup
2), reduction
was
complished
of fourteen
group
lower
with the Pavlik
hips in subgroup
3 , and one
extremities
lik harness.
displacement
Patients
few
days
VOL.
65-A,
hip in subgroup
before
definitive
application
6,
JULY
1983
of the Pavlik
for
uneventfully
2 and
harness
indicates
following
3 had
within
a
the
the
Pavlik
harness.
stabilization
of the joint.
characteristics.
First,
the
child
assumed
an
or stand
while
position
duction
is forced
by the
is thus facilitated
wearing
Traction
was
1) when reduction
the harness
(Fig.
6-A),
use of a restraining
(Fig. 6-B).
employed
in the
was not achieved
but a supine
belt
and
re-
following
situations:
by the Pavlik
harness
within
seven
to ten days even after the described
procedures
were
tried,
(2) when
the medial
corner
of the
metaphysis
was superior
to the Hilgenreiner
line’ , and (3)
when there was a severe
flexion
and adduction
contracture
of the hip with pronounced
dislocation.
These factors
were
severe
showed
with
oblique
posture
with the affected
hip joint adducted
(Fig.
4-A).
In order to correct
this obliquity,
a pillow
was used
to abduct
the hip and achieve
reduction
(Fig.
4-B).
Sec-
(
traction
of the
of the Pay-
not possible
hip
ac-
alone.
However,
five
of eleven
hips in sub-
2 required
application
The five hips in subgroups
or contractures.
in whom reduction
was
after
NO.
harness
1 , four
random
reduction
ond, the knee joint in these patients
assumed
an angle of
flexion
of more than 90 degrees
(Fig.
5-A),
and this was
reduced
by the application
of a splint at the popliteal
fossa
(Fig. 5-B). Babies
older than the age of six months
can sit
All of the children
who were hospitalized
had a successful
reduction
with the use of the Pavlik
harness
but ten
of them had required
traction
in addition
(Table
III). Five
of these ten patients
had had unsuccessful
the harness
as outpatients.
In twenty-four
hips
in twenty-three
patients
who
were
after
3
FIG.
Active
763
HARNESS
present
application
mainly
in the outpatients
of the
harness.
who
had
had
inadequate
764
KATSURO
IWASAKI
FIG.
This
child
with
a dislocation
of the
left
hip
assumes
FIG.
The
oblique
posture
is corrected
medial
Pavlik
corner
of the
Hilgenreiner
metaphysis
line,
traction
harness
was applied.
The roentgenographic
descended
was
to the
discontinued
examination
that
level
and
was
carried
there
was
tremities
those
no
for
with
spontaneous
more
marked
than
patients
was 28 per cent. Avasfrequent
in patients
in whom
movement
one
swelling.
month
of
after
the
reduction
lower
exand
in
after
application
of the
Pavlik
harness.
4-B
seen
old
quired
of
the
out one year after reduction
revealed
avascular
necrosis
of
the femoral
capital
epiphysis
in fourteen
of the patients
who had been hospitalized
(Table
III). This complication
was seen in ten of twenty-five
hips of patients
who were
less than six months
old (subgroup
2), and the over-all
incidence
in the hospitalized
cular necrosis
was especially
posture
by a pillow
The customary
regimen
of traction
used at our institution
consisted
of skin traction
with the hip extended
and abducted
to not more
than 45 degrees.
The force of
traction
was between
one and two kilograms.
When
the
the
4-A
an oblique
placed
behind
Acetabular
in the hips
at the
the
back.
dysplasia,
of patients
start
on the other hand,
was mainly
who were more than six months
of treatment
traction.
The incidence
and
in patients
of anatomical
healing
who
after
had
three
re-
years
of follow-up
was 56 per cent for the hospitalized
patients
(Table
III).
Deformity
of the femoral
head
persisted
in
twelve
of fourteen
hips in which
avascular
necrosis
had
occurred
one year
continued
in ten
after
reduction,
of thirteen
and acetabular
dysplasia
hips.
Discussion
Compared
with
lik harness
is simple
extremity
the child.
other than extension,
In order to achieve
complications
quite
several
other devices
in use, the Payand allows
movements
of the lower
important.
,
however
To
,
control
understand
THE
so that it is comfortable
for
successful
healing
without
JOURNAL
dun ng
how
OF
BONE
the
application
harness
AND
JOINT
is
works,
SURGERY
TREATMENT
BY
THE
PAVLIK
765
HARNESS
1’
.
-
FIG.
The
left
knee
joint
on the
affected
side
assumes
FIG.
The
more information
obtained.
With
the
important
on the
reference
role
contraction
ness.
Sakaguchi
tivity
of the
tension
and
of the knee
these
reports
of
dislocation.
In my
tion
ment
of the
Relief
harness
Ramsey
et al.
the
indispensable
before
reduction,
extremity,
non
is especially
cle
tone,
with
the
tion
of
as
the
flexed
mentioned
deep
and
harness
efficient
relief of the
and the most abduction
VOL.
65-A,
NO.
6, JULY
and
to
from
a superior
acetabulum,
Furthermore,
which
when
reduce
after
scarcely
by
Suzuki.
moveafter
sleep
when
PavIIk
regarded
accomplished
be
one
that
patient
method
achieves
but
of the
phenome-
of decreased
the
The
re-
described.
This
in a state
the
applica-
any
immediately
which
abducted.
should
head
of the lower extremity,
muscles
by the weight
pronounced
as during
hip
help
is probably
not by spontaneous
movement
by stretching
of the adductor
ac-
All of
mus-
is supine
of applicathe
most
contracture
of the adductor
muscles
of the hip joint by the weight
of the
1983
should
then
of
position
tion
acting
being
the
acting
during
by flexion
position
source
of
the
femoral
aspect
power.
of reduction
the
Either
of the
of the hip joint.
is assumed,
the
role of
allowing
anteriorly
Thus,
reduction,
easy
Pavlik
the
plays the important
and consequently
at the time
manual
of
to the posterior
is promoted
the abducted
and
of the
a shift
femoral
head
to slide
and into the acetabulum.
of the power
as that
prompt
by means
consists
weight
of the lower
extremity
stretching
the adductor
muscles
the dislocated
acetabular
rim
ensure
of reduction
ex-
spontaneous
ofreductionjust
contracture,
for
lower
to
I noted
theory
of the adductor
for
90 degrees.
fossa.
probably
the
the dislocation.
of children
however,
to the
flexion
most
and
described
need
extremity
extremities
This
and
spontaneous
popliteal
extremity.
har-
observations
contrary
lower
at the
by
to reduce
lower
of the harness,
duction,
as
the
a splint
muscle
the
than
5-B
by applying
quadriceps
during
acting
of more
as affected
of the
later
of flexion
muscles
suggested
movements
is corrected
a position
reduction.
The mechanism
gluteal
hamstrings
of flexion
mechanism
of reduction
must be
to this, Mittelmeier
pointed
out
of activity
of the
position
5-A
the
over the
the direcis the same
only
difference
weight
of
the
lower
extremity
itself or the manual
power
of an operator
can lever the femoral
head into the reduced
position.
Reduction
was successfully
accomplished
by application
of the Pavlik
dren in this series.
with
those
vealed
cular
cent
in the
two
necrosis
children
problems
of the
of the outpatients,
per cent
harness
However,
in the children
in all of the hospitalized
comparison
of these
treated
with
femoral
the
on an outpatient
Pavlik
head
method.
was
but the incidence
who
were
found
chilresults
basis
First,
in 7.2
was as high
hospitalized.
This
re-
avasper
as 28
higher
766
KATSURO
IWASAKI
6-A
FIG.
This
baby,
more
than
six
months
old,
is able
FIG.
In order
rate
was
series
similar
to the incidence
of patients
treated
Lorenze
method.
healing
was
children
with
in these
The
difficult
severe
patients
were
group,
although
were hospitalized
use
cation
These
bear in mind
the hip with
Nagasaki
problem
achieve
older
displacement.
often
Pavlik
observations
band
well
as
into
that
in a
by the
anatomical
children
and
in
in the
prior
to appli-
harness.
suggest
two
important
points
in the treatment
of congenital
dislocation
the Pavlik
harness:
( 1 ) in patients
with
position,
to
of
con-
harness
is applied.
a restraining
belt
is used.
genital
dislocation
of the hip that cannot
be reduced
easily
organic
and irreversible
changes
have already
occurred
in
the hip joint so that complete
recovery
is not always
possible
even
limb
outpatient
the children
through
the
the
6-B
tempts
at reduction
evident
achieved
traction
a supine
necrosis
Attempts
unsuccessful
as
child
University
was
in
when
that became
and reduction
was
of a restraining
of the
second
the
of avascular
at the
to
to force
to sit after
after
reduction,
at reduction
are
and
too
is forced
into
abduction
weight
of the
lower
extremity
Pavlik
harness
malaise
on
joint may
In children
motion
apt
is not
the
part
become
with
of the hip,
to occur.
This
(2)
the
that
-
in order
on
always
of
in patients
strenuous
the
a safe
child
and
in whom
at-
is, when
the
to apply
hip
and
the whole
even the
gentle
method;
joint
-
swelling
of
the
hip
evident
if the hip is in a forced
position.
severe
symptoms
of malaise
and pain on
avascular
necrosis
is probably
THE
JOURNAL
due
of the femoral
to the excessive
OF BONE
AND
JOINT
head
abducSURGERY
is
TREATMENT
BY
THE
PAVLIK
767
HARNESS
.d
-.:
.
.
‘.‘
FIG.
Pillows
tion
of
the
Ramsey
the
hip
joint
et al.,
femoral
can
the
excessive
head,
phenomena
ness
beyond
so that
safe
applied
zone
under
when
to reduce
by
degree
and duration
of such weight
being
most important.
The child will respond
to an application
of unnatural
force
to
necrosis.
application
Such
of
the
in his
har-
What
is the
After
tremities
proper
method
application,
should
100 degrees
be
of application
the
position
adjusted
of flexion
of the har-
of
to ensure
the
that
of the hip joint
lower
there
as the
ex-
is 90
to
fundamental
position.
Subsequent
adjustments
should
be based on careful observation
of the position
of the extremities
and of the
systemic
and
reaction
excessive
child
flexion
is able
harness
the
toward
knee
stand,
weight
abduction
are
or her
lower
(Figs.
4-A
way,
of abduction
In the
probably
crying.
who
avascular
may
were
the
of
external
Regulation
of the
abduction
infancy,
must
be kept
extremity
through
must
6-B),
re-
be diwith
the
the
Pavlik
patient
clinic
the next step
Pavlik
harness
but,
to reduce
the
as outpatients,
the
femoral
power
the
head
acting
was
on
the
was decreased
when
the mother
held the
him or her on her back in response
to the
If the
means
described,
be required.
treated
of the
posture
been
be applied
may
necrosis
because
femoral
head
baby or carried
already
or traction
children
of
as has
7, pillows
by
children
of the
own
in Figure
incidence
low,
of abduction.
unacceptable.
oblique
reduction
such
angle
in this way in outpatient
treatment.
In the treatment
of congenital
A constant
of the
is impossible;
and
rected
child.
to sit and
alone
cumbent
of the
the
as shown
angle
is improper.
ness?
7
knees
is applied
avascular
occur
the
described
compression
causing
easily
are
first.
should
harness
should
If successful
be traction
during
force
might
dislocation
be employed
reduction
and then
be exerted
of the hip in
in the
out-
is not obtained,
application
of the
hospitalization.
References
1. GAGE,
J. R., and
Dislocation
ofthe
March
2.
I5HIDA,
Surg.],
3.
MITTELMEIER,
7.
8.
9.
10.
11.
12.
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HEINZ:
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Review
Necrosis
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ofTwenty
Years’
Experience
Femoral
Epiphysis
as a Complication
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atGillette
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J. Bone and Joint Surg.,
of Congenital
54-A:
373-388,
Beitrag
eine
52: 465-522,
zur
Kritik
Unreduced
funktionellen
der klassischen
Cases
by Pavlik
Harness
in Congenital
Therapie
und Spontanreposition
der
Behandlungstechnik
mit manueller
Dislocation
angeborenen
Reposition
ofthe
Hip.l
Rinsho
Luxationshiifte
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GARFIN,
STEVEN;
VANCE,
RAYMOND;
MCKINNON,
BERT;
and SUTHERLAND,
DAVID:
Pitfalls
in the Use of the Pavlik
Harness
of Congenital
Dysplasia,
Subluxation,
and Dislocation
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1239- 1248,
Oct.
1981.
PAVLITK,
ARNOLD:
Die funktionelle
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mittels
Riemenb#{252}gel als Prinzip
der konservativen
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RAMSEY,
P. L.; LASSER,
STEPHEN;
and MACEWEN,
G. D.: Congenital
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Harness
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the
First Six Months
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J. Bone
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58-A:
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Oct.
1976.
SAKAGUCHI,
R.: [Treatment
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2: 679-707,
1967.
SALTER,
R. B.; KOSTUIK,
J.; and DALLAS,
S.: Avascular
Necrosis
of the Femoral
Head as a Complication
of Treatment
for Congenital
Dislocation of the Hip in Young Children:
A Clinical
and Experimental
Investigation.
Canadian
J. Surg. , 12: 44-61 , 1969.
SUZUKI,
R.: Complications
of the Treatment
of Congenital
Dislocation
of the Hip by the Pavlik
Harness.
Internat.
Orthop.
, 3:
77-79,
1979.
YAMADA,
K.; HACHIYA,
M.; SUGIMOTO,
K.; HIRAI,
M.; TUCHIYA,
K.; FURUHASHI,
K.; YAMAMOTO,
M.; and YAMASHITA,
Y.: [The Causes
and
Treatment
of Unsuccessful
CDH
Cases
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by Pavlik
Bandage.]
Rinsho
Seikei
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[Clin.
Orthop.
Surg.],
16: 278-284,
1981.
YAMAMURO,
T.; OKA,
M.; and I5HIDA,
K.: [Long Term Results
oflreatment
ofCongenital
Dislocation
ofthe
Hip with Pavlik’s
Harness
and Its
Controversial
Points.]
J. Japanese
Orthop.
Assn. , 48: 796,
1974.
YANO,
T.: [Causes
of Unreduced
CDH with Pavlik’s
Bandage
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Rinsho
Seikei
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16: 275-277,
1981.
MUBARAK,
for
6.
R. B.: Avascular
A Critical
K.: [Investigation
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13: 204-211,
1978.
Unfall-Chir.,
5.
Hip.
1972.
likbandage.
4.
WINTER,
SCOTT;
Treatment
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NO.
6, JULY
1983