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The efficacy of the Pavlik harness, the Craig splint and the von Rosen splint in the management of neonatal dysplasia of the hip

A COMPARATIVE STUDY

Department of Radiology, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK.

G. D. Murray, FRCP Ed, Professor of Medical Statistics

Department of Community Health Sciences (Public Health Sciences), University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK.

Correspondence should be sent to Dr A. G. Wilkinson at the Department of Radiology, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH11 9LF, UK.

We have reviewed the outcome of 134 hips in 96 children with Graf type-III or type-IV dysplasia of the hip on ultrasound examination. We treated 28 affected hips in 22 children with the Craig splint, 43 hips in 30 children with the Pavlik harness, and 26 hips in 16 children with the von Rosen splint. A total of 37 affected hips in 28 children was not splinted. All children were less than three months of age at referral.

Those treated with the von Rosen splint had a significantly better ultrasound appearance at 12 to 20 weeks of age and fewer radiological abnormalities than those not splinted or treated with the Pavlik harness. In the von Rosen group no hip required further treatment with an abduction plaster or operation compared with ten in the Pavlik harness group, three in the Craig splint group and eight in the group without splintage.

Our results suggest that the von Rosen splint is more likely to improve the outcome of neonatal dysplasia of the hip and a definitive, large-scale randomised trial is therefore indicated.

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