How is closed reduction performed for the treatment of developmental dysplasia of the hip (DDH)?

Updated: Feb 26, 2018
  • Author: Junichi Tamai, MD; Chief Editor: William L Jaffe, MD  more...
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Answer

Historically, traction was performed for a 2- to 3-week period before closed reduction was attempted. [68] Traction (usually skin traction) was performed either at home or in the hospital. This required careful monitoring to ensure the integrity of the skin. Although there remains considerable controversy regarding the overall benefit of traction, reports of long-term follow-up have shown satisfactory outcomes in a majority of patients. [69, 70]

Closed reduction is typically performed with the aid of arthrography, which is used to determine the adequacy of the reduction. A medial dye pool and an interposing limbus are both associated with a poor prognosis. If, on the other hand, a sharp or even a blunted limbus and no medial dye pooling are present, the prognosis is good. [71] In addition, the safe zone of Ramsey (ie, the angle between the maximum abduction and minimum abduction in which the hip remains reduced) should be at least 25º and can be increased with release of the adductor longus.

The cone of stability—a cone that involves hip flexion, abduction, and internal or external rotation—has also been defined. If this cone measures greater than 30º, it is considered satisfactory. [71]

A spica cast is placed, with care taken in molding over the posterior aspect of the greater trochanter of the ipsilateral limb. After this is done, computed tomography (CT) or magnetic resonance imaging (MRI) is performed to ensure that no evidence of posterior subluxation is present. The cast is typically worn for 6-12 weeks, at which time the hip is reexamined. If the hip is found to be stable, the patient is placed in an abduction brace. If the hip remains unstable, the patient is again placed in a spica cast.


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