Closed Reduction of Developmental Dislocation of the Hip with Application of a Waterproof Cast

Abstract

Developmental dysplasia of the hip (DDH) is a common orthopaedic condition in infants with an incidence of 1 in 1000 infants. An ultrasound can be performed at 6 weeks if the infant exhibits any risk factors, either intrauterine or at birth. If an ultrasound is positive for DDH, treatment typically begins with a dynamic brace such as the Pavlik harness. If bracing is unsuccessful or the infant presents at an age deemed too late to start brace treatment, closed reduction should be considered. Typically, this is done under anesthesia holding the infant in the so-called human position and maintaining this for at least three months. One of the significant challenges of casting after a closed reduction is maintaining hygiene for the entire 3 months of treatment. This paper presents a detailed surgical technique guide to help physicians with closed reduction, casting with waterproof material, and advanced perioperative imaging to confirm reduction. Key Concepts • Developmental dysplasia of the hip (DDH) is a common orthopaedic condition in infants with an incidence of 1 in 1000 infants. • The standard intervention after Pavlik harness or abduction bracing is closed reduction and casting. • Waterproof casting addresses the significant challenge of maintaining hygiene for the full 3 months of treatment after closed reduction and casting for DDH. • Confirmation of closed reduction can be achieved with arthrogram or advanced imaging such as 3D CT.