Preoperative Gallows traction as an adjunct to hip open reduction surgery: Is it safe and is it effective?
Background: Traction is used at our hospital before open reduction in infants with developmental dysplasia of the hip. Theoretically, it reduces soft-tissue tension, allowing an easier surgical reduction and therefore lower surgical complications. Owing to extended hospital stays, potential complica...
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| Veröffentlicht in: | Journal of children's orthopaedics 2024-04, Vol.18 (2), p.171-178 |
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| creator | Uren, Nicholas C Judd, Julia Lindisfarne, Edward A Elliott, Kirsten G Aarvold, Alexander |
| description | Background:
Traction is used at our hospital before open reduction in infants with developmental dysplasia of the hip. Theoretically, it reduces soft-tissue tension, allowing an easier surgical reduction and therefore lower surgical complications. Owing to extended hospital stays, potential complications, and lack of evidence, the use of traction has decreased. This study aims to quantify whether traction is safe and whether it has any demonstrable effect.
Methods:
The perioperative course of 80 patients undergoing preoperative traction and hip open reduction were reviewed. The height of hip dislocation was classified using the International Hip Dysplasia Institute classification system on both radiographs taken before and after traction. Any complications related to traction were recorded, along with the requirement for femoral shortening osteotomies, incidence of re-dislocation, and longer-term rate of avascular necrosis.
Results:
Traction lowered the resting position of the majority of hips, with the median International Hip Dysplasia Institute grade before traction improving from 4 to 3, a statistically significant improvement (p |
| doi_str_mv | 10.1177/18632521241229620 |
| format | Article |
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Traction is used at our hospital before open reduction in infants with developmental dysplasia of the hip. Theoretically, it reduces soft-tissue tension, allowing an easier surgical reduction and therefore lower surgical complications. Owing to extended hospital stays, potential complications, and lack of evidence, the use of traction has decreased. This study aims to quantify whether traction is safe and whether it has any demonstrable effect.
Methods:
The perioperative course of 80 patients undergoing preoperative traction and hip open reduction were reviewed. The height of hip dislocation was classified using the International Hip Dysplasia Institute classification system on both radiographs taken before and after traction. Any complications related to traction were recorded, along with the requirement for femoral shortening osteotomies, incidence of re-dislocation, and longer-term rate of avascular necrosis.
Results:
Traction lowered the resting position of the majority of hips, with the median International Hip Dysplasia Institute grade before traction improving from 4 to 3, a statistically significant improvement (p < 0.00001). There were no neurovascular complications. Two babies were complicated with broken skin sores; however, surgery still progressed uneventfully. Zero hips in the cohort required femoral shortening osteotomies to achieve a tension-free reduction, and the re-dislocation rate was 0%. However, 96% of hips were Severin 1 or 2 at 6-year follow-up.
Conclusion:
Notably, 1 week of preoperative traction significantly improves the resting position of the hip in high dislocations. It is safe when used in infants weighing <12 kg, and subsequent surgical outcomes are excellent, thus supporting its use ahead of developmental dysplasia of the hip open reduction surgery.
Level of evidence:
Level IV.</description><identifier>ISSN: 1863-2521</identifier><identifier>EISSN: 1863-2548</identifier><identifier>DOI: 10.1177/18632521241229620</identifier><identifier>PMID: 38567049</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Hip dislocation ; Hip disorders ; Hip joint ; Orthopedics ; Pediatrics ; Surgery ; Surgical outcomes</subject><ispartof>Journal of children's orthopaedics, 2024-04, Vol.18 (2), p.171-178</ispartof><rights>The Author(s) 2024</rights><rights>The Author(s) 2024.</rights><rights>The Author(s) 2024 2024 European Pediatric Orthopaedic Society (EPOS), unless otherwise noted. Manuscript content on this site is licensed under Creative Commons Licenses.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c467t-b9a9836e15f4283b3d94b452cab27744936943b452347860cc6bb95236323cf3</citedby><cites>FETCH-LOGICAL-c467t-b9a9836e15f4283b3d94b452cab27744936943b452347860cc6bb95236323cf3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984156/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984156/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,21945,27830,27901,27902,44921,45309,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38567049$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Uren, Nicholas C</creatorcontrib><creatorcontrib>Judd, Julia</creatorcontrib><creatorcontrib>Lindisfarne, Edward A</creatorcontrib><creatorcontrib>Elliott, Kirsten G</creatorcontrib><creatorcontrib>Aarvold, Alexander</creatorcontrib><title>Preoperative Gallows traction as an adjunct to hip open reduction surgery: Is it safe and is it effective?</title><title>Journal of children's orthopaedics</title><addtitle>J Child Orthop</addtitle><description>Background:
Traction is used at our hospital before open reduction in infants with developmental dysplasia of the hip. Theoretically, it reduces soft-tissue tension, allowing an easier surgical reduction and therefore lower surgical complications. Owing to extended hospital stays, potential complications, and lack of evidence, the use of traction has decreased. This study aims to quantify whether traction is safe and whether it has any demonstrable effect.
Methods:
The perioperative course of 80 patients undergoing preoperative traction and hip open reduction were reviewed. The height of hip dislocation was classified using the International Hip Dysplasia Institute classification system on both radiographs taken before and after traction. Any complications related to traction were recorded, along with the requirement for femoral shortening osteotomies, incidence of re-dislocation, and longer-term rate of avascular necrosis.
Results:
Traction lowered the resting position of the majority of hips, with the median International Hip Dysplasia Institute grade before traction improving from 4 to 3, a statistically significant improvement (p < 0.00001). There were no neurovascular complications. Two babies were complicated with broken skin sores; however, surgery still progressed uneventfully. Zero hips in the cohort required femoral shortening osteotomies to achieve a tension-free reduction, and the re-dislocation rate was 0%. However, 96% of hips were Severin 1 or 2 at 6-year follow-up.
Conclusion:
Notably, 1 week of preoperative traction significantly improves the resting position of the hip in high dislocations. It is safe when used in infants weighing <12 kg, and subsequent surgical outcomes are excellent, thus supporting its use ahead of developmental dysplasia of the hip open reduction surgery.
Level of evidence:
Level IV.</description><subject>Hip dislocation</subject><subject>Hip disorders</subject><subject>Hip joint</subject><subject>Orthopedics</subject><subject>Pediatrics</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><issn>1863-2521</issn><issn>1863-2548</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><recordid>eNp1kU1PGzEQhq2qVaHAD-ilssSFS6i_P7igClFAQoIDd8vrnQ2ONuvU3qXi3-MQCKVVL7Zn_LyvPTMIfaXkmFKtv1OjOJOMMkEZs4qRD2h3nZsxKczH7ZnRHfSllAUhilhrPqMdbqTSRNhdtLjNkFaQ_RgfAF_4vk-_Cx6zD2NMA_YF-7q2i2kIIx4Tvo8rXPkBZ2inDVOmPIf8eIKvCo4jLr6DKmpxfA6h6yCszU_30afO9wUOXvY9dPfz_O7scnZ9c3F19uN6FoTS46yx3hqugMpOMMMb3lrRCMmCb5jWQliurODrDBfaKBKCahpbo9oLHjq-h043tqupWUIbYKjV9G6V49LnR5d8dO9vhnjv5unBUWKNoFJVh6MXh5x-TVBGt4wlQN_7AdJUHCecKmmNNBU9_AtdpCkPtbxKSU20rW2uFN1QIadSMnTb31Di1pN0_0yyar79WcZW8Tq6ChxvgOLn8Pbs_x2fAKZJpV4</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Uren, Nicholas C</creator><creator>Judd, Julia</creator><creator>Lindisfarne, Edward A</creator><creator>Elliott, Kirsten G</creator><creator>Aarvold, Alexander</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>AFRWT</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20240401</creationdate><title>Preoperative Gallows traction as an adjunct to hip open reduction surgery: Is it safe and is it effective?</title><author>Uren, Nicholas C ; Judd, Julia ; Lindisfarne, Edward A ; Elliott, Kirsten G ; Aarvold, Alexander</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c467t-b9a9836e15f4283b3d94b452cab27744936943b452347860cc6bb95236323cf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Hip dislocation</topic><topic>Hip disorders</topic><topic>Hip joint</topic><topic>Orthopedics</topic><topic>Pediatrics</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Uren, Nicholas C</creatorcontrib><creatorcontrib>Judd, Julia</creatorcontrib><creatorcontrib>Lindisfarne, Edward A</creatorcontrib><creatorcontrib>Elliott, Kirsten G</creatorcontrib><creatorcontrib>Aarvold, Alexander</creatorcontrib><collection>Sage Journals GOLD Open Access 2024</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of children's orthopaedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Uren, Nicholas C</au><au>Judd, Julia</au><au>Lindisfarne, Edward A</au><au>Elliott, Kirsten G</au><au>Aarvold, Alexander</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative Gallows traction as an adjunct to hip open reduction surgery: Is it safe and is it effective?</atitle><jtitle>Journal of children's orthopaedics</jtitle><addtitle>J Child Orthop</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>18</volume><issue>2</issue><spage>171</spage><epage>178</epage><pages>171-178</pages><issn>1863-2521</issn><eissn>1863-2548</eissn><abstract>Background:
Traction is used at our hospital before open reduction in infants with developmental dysplasia of the hip. Theoretically, it reduces soft-tissue tension, allowing an easier surgical reduction and therefore lower surgical complications. Owing to extended hospital stays, potential complications, and lack of evidence, the use of traction has decreased. This study aims to quantify whether traction is safe and whether it has any demonstrable effect.
Methods:
The perioperative course of 80 patients undergoing preoperative traction and hip open reduction were reviewed. The height of hip dislocation was classified using the International Hip Dysplasia Institute classification system on both radiographs taken before and after traction. Any complications related to traction were recorded, along with the requirement for femoral shortening osteotomies, incidence of re-dislocation, and longer-term rate of avascular necrosis.
Results:
Traction lowered the resting position of the majority of hips, with the median International Hip Dysplasia Institute grade before traction improving from 4 to 3, a statistically significant improvement (p < 0.00001). There were no neurovascular complications. Two babies were complicated with broken skin sores; however, surgery still progressed uneventfully. Zero hips in the cohort required femoral shortening osteotomies to achieve a tension-free reduction, and the re-dislocation rate was 0%. However, 96% of hips were Severin 1 or 2 at 6-year follow-up.
Conclusion:
Notably, 1 week of preoperative traction significantly improves the resting position of the hip in high dislocations. It is safe when used in infants weighing <12 kg, and subsequent surgical outcomes are excellent, thus supporting its use ahead of developmental dysplasia of the hip open reduction surgery.
Level of evidence:
Level IV.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>38567049</pmid><doi>10.1177/18632521241229620</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | DOAJ Directory of Open Access Journals; Sage Journals GOLD Open Access 2024; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Hip dislocation Hip disorders Hip joint Orthopedics Pediatrics Surgery Surgical outcomes |
| title | Preoperative Gallows traction as an adjunct to hip open reduction surgery: Is it safe and is it effective? |
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