Clinical and radiological results of pelvipeal casting and rigid abduction orthosis applications in the treatment of patients with developmental hip dysplasia

Objective: In this study, it was aimed to evaluate the clinical and radiological results of rigid abduction orthosis and pelvipedal casting in patients with acetabular dysplasia aged 4-15 months. Materials and Methods: This study was conducted in Harran University Medical Faculty Hospital Orthopedics and it was performed in the Traumatology Clinic between November 2021 and March 2023, by including 71 hips of 41 patients with negative Ortholoni and Barlow tests between the ages of 4-15 months. Thirty-seven hips of 21 patients were treated with rigid abduction orthosis and 34 hips of 20 patients were treated with pelvipedal casting. IHDI, Tönnis and acetabular index measurements of the patients were measured before and after the treatment. Treatment responses between the groups were compared. Patients older than 15 months, cerebral palsy (n=3), congenital anomaly (n=2), Ortolani or Barlow positive (n=18), incompitable to follow-up (n=5), refused to participate in the study ( n=4), underwent adductor tenotomy due to abduction limitation (n=2) were excluded from the study. Results: There was no significant difference between the pre-treatment groups according to the IHDI classification of the patients, but there was a statistically significant difference in favor of the plaster group in the treatment response according to the IHDI classification between the two groups at the 3rd month of treatment (P=0.039). According to the Tönnis classification of the patients, there was no significant difference between the groups before the treatment, but there was a significant difference between the groups in the 3rd month of the treatment in favor of the plaster group in the 3rd month of the treatment (P=0.027). XII The mean AI of the patients in the plaster group was 35.82±2.71 (minimum-maximum: 32- 41) and the mean AI of the patients in the orthosis group was 36.54±3.49 (minimum-maximum: 32- 47). There was no statistically significant difference between the groups (P=0.34). In the radiological examination performed at the 3rd month during the treatment process of the patients; the mean AI was 29.17±3.45 (minimum-maximum: 23-37) in the plaster group and 30.08±3.91 (minimum-maximum: 23-39) in the orthosis group. There was no statistically significant difference between the groups (P=0.31). In the radiological examination performed at the 6th month during the treatment process of the patients; the mean AI was 24.11±38.4 (minimum-maximum: 17-22) in the plaster group and 25.67±3.17 (minimum-maximum: 19-33) in the orthosis group. There was no statistically significant difference between the groups (P=0.06). Conclusion: As a result of this study, we concluded that closed reduction-guided pelvipedal casting and rigid abduction orthosis used in 4-15 months old patients with acetabular dysplasia and negative Ortholoni and Barlow tests are effective in the treatment. We found a statistically significant difference in the first 3 months of treatment in patients who were followed up with a pelvipedal cast according to the Tönnis and IHDI classification, in the comparison of the patients who underwent pelvic casting and the patient group using rigid abduction orthosis. We did not find any significant difference between the groups according to the AI measurement used in the diagnosis and treatment follow-up of the patient groups using the pelvic cast and rigid abduction orthosis. Keywords: Developmental Hip Dysplasia, Acetabular Dysplasia, Open Reduction, Pelvipedal Casting, Rigid Abduction Orthosis