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A Pavlik harness with the hips in 90 degrees of flexion and 60 degrees of abduction
39%
204/525
A spica cast with the hips in 100 degrees of flexion and 70 degrees of abduction
3%
18/525
Observation with range-of-motion exercises to minimize contractures
53%
277/525
Open reduction through an anterior hip approach
2%
9/525
Open reduction through a medial hip approach
1%
7/525
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The status of the hips (located or dislocated) in children with thoracic-level myelomeningocele has no effect on the functional outcome of these patients. Management of unstable hips in this population should be limited to treatment of the contractures that may lead to poor limb positioning in either braces or a wheelchair. The use of the Pavlik harness and/or spica cast is contraindicated because they would promote flexion and abduction contractures. In the past, open reduction either through an anterior or medial approach had been performed with a high incidence of redislocation and other complications, with little functional gain for the child.
4.1
(16)
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