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The effectiveness of preliminary traction in the treatment of congenital dislocation of the hip

BACKGROUND: Historical papers on the treatment of congenital dislocation of the hip suggest the use of preliminary traction to facilitate closed reduction or to decrease the risk of avascular necrosis (AVN) of the femoral head. In the 1980s, some authors questioned the role of preliminary traction a...

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Autores principales: Farsetti, Pasquale, Efremov, Kristian, Caterini, Alessandro, Marsiolo, Martina, De Maio, Fernando, Ippolito, Ernesto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236418/
https://www.ncbi.nlm.nih.gov/pubmed/34180020
http://dx.doi.org/10.1186/s10195-021-00586-8
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author Farsetti, Pasquale
Efremov, Kristian
Caterini, Alessandro
Marsiolo, Martina
De Maio, Fernando
Ippolito, Ernesto
author_facet Farsetti, Pasquale
Efremov, Kristian
Caterini, Alessandro
Marsiolo, Martina
De Maio, Fernando
Ippolito, Ernesto
author_sort Farsetti, Pasquale
collection PubMed
description BACKGROUND: Historical papers on the treatment of congenital dislocation of the hip suggest the use of preliminary traction to facilitate closed reduction or to decrease the risk of avascular necrosis (AVN) of the femoral head. In the 1980s, some authors questioned the role of preliminary traction and suspended its use, yielding satisfactory results. Since then, several studies called into question this method, and some authors have continued to recommend preliminary traction while other authors have discouraged its use. MATERIALS AND METHODS: We reanalysed the full set of radiographs of 71 hips (52 patients) surgically treated by a medial approach after 4 weeks of preoperative longitudinal traction. The mean age at operation was 16 months. Before and after traction, the height of the dislocation was graded according to the Gage and Winter method. The hips were divided into two groups: group 1, in which the traction was effective, and group 2, in which the traction was not effective. These two groups were statistically analysed regarding the severity of the dislocation, the age of the patient at surgery and the incidence of AVN. RESULTS: Preliminary traction was effective in 48 hips (68%, group 1), while it was not effective in the remaining 23 (32%, group 2). The effectiveness of preliminary traction was statistically related to the height of the dislocation and to the age of the patient at surgery, with traction being less effective in more severe dislocations and in older children. The incidence of AVN was statistically lower in group 1 than in group 2. CONCLUSIONS: In our study population, despite not having a control group, preliminary traction—when effective—seemed to reduce the incidence of AVN in patients surgically treated for congenital dislocation of the hip. The effectiveness of the traction was influenced by the severity of the dislocation and the age of the patient; it worked better for less severe dislocations and in younger children. To reduce hospital costs, traction should be applied at home. LEVEL OF EVIDENCE: 3.
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spelling pubmed-82364182021-07-09 The effectiveness of preliminary traction in the treatment of congenital dislocation of the hip Farsetti, Pasquale Efremov, Kristian Caterini, Alessandro Marsiolo, Martina De Maio, Fernando Ippolito, Ernesto J Orthop Traumatol Original Article BACKGROUND: Historical papers on the treatment of congenital dislocation of the hip suggest the use of preliminary traction to facilitate closed reduction or to decrease the risk of avascular necrosis (AVN) of the femoral head. In the 1980s, some authors questioned the role of preliminary traction and suspended its use, yielding satisfactory results. Since then, several studies called into question this method, and some authors have continued to recommend preliminary traction while other authors have discouraged its use. MATERIALS AND METHODS: We reanalysed the full set of radiographs of 71 hips (52 patients) surgically treated by a medial approach after 4 weeks of preoperative longitudinal traction. The mean age at operation was 16 months. Before and after traction, the height of the dislocation was graded according to the Gage and Winter method. The hips were divided into two groups: group 1, in which the traction was effective, and group 2, in which the traction was not effective. These two groups were statistically analysed regarding the severity of the dislocation, the age of the patient at surgery and the incidence of AVN. RESULTS: Preliminary traction was effective in 48 hips (68%, group 1), while it was not effective in the remaining 23 (32%, group 2). The effectiveness of preliminary traction was statistically related to the height of the dislocation and to the age of the patient at surgery, with traction being less effective in more severe dislocations and in older children. The incidence of AVN was statistically lower in group 1 than in group 2. CONCLUSIONS: In our study population, despite not having a control group, preliminary traction—when effective—seemed to reduce the incidence of AVN in patients surgically treated for congenital dislocation of the hip. The effectiveness of the traction was influenced by the severity of the dislocation and the age of the patient; it worked better for less severe dislocations and in younger children. To reduce hospital costs, traction should be applied at home. LEVEL OF EVIDENCE: 3. Springer International Publishing 2021-06-27 2021-12 /pmc/articles/PMC8236418/ /pubmed/34180020 http://dx.doi.org/10.1186/s10195-021-00586-8 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Farsetti, Pasquale
Efremov, Kristian
Caterini, Alessandro
Marsiolo, Martina
De Maio, Fernando
Ippolito, Ernesto
The effectiveness of preliminary traction in the treatment of congenital dislocation of the hip
title The effectiveness of preliminary traction in the treatment of congenital dislocation of the hip
title_full The effectiveness of preliminary traction in the treatment of congenital dislocation of the hip
title_fullStr The effectiveness of preliminary traction in the treatment of congenital dislocation of the hip
title_full_unstemmed The effectiveness of preliminary traction in the treatment of congenital dislocation of the hip
title_short The effectiveness of preliminary traction in the treatment of congenital dislocation of the hip
title_sort effectiveness of preliminary traction in the treatment of congenital dislocation of the hip
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236418/
https://www.ncbi.nlm.nih.gov/pubmed/34180020
http://dx.doi.org/10.1186/s10195-021-00586-8
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