Pavlik harness

Discussion: 

    - Pavlik harness is a dynamic flexion abduction orthosis used to treat DDH in infants up to 6 months of age
    - harness usually leads to stability of reduced hip w/ in 4 wks, but its use should  be continued until clinical exam & x-rays
          of hip are normal; 
    - patient's should expect a 85-95% success rate if the diagnosis is made in the newborn nursery; 
           - clearly, a lower success rate would be expected w/ a teratologic dislocation; 
    - indications and contra-indications:
           - indicated for infants w/ DDH & who are younger than six months; 
           - not indicated for infants w/ a "hip click" but a normal physical exam (Barlow's test and Ortolani's test); 
           - if teratologic dislocation is present, Pavlik harness is not used; 



    - cautions: 
           - note that continued dislocation of a hip while in Pavlik harness stretches the posterior capsule and reduces chances of 
                     maintaining good reduction later; 
           - note that male patients and patients w/ bilateral dislocations may have worse results w/ the Pavlik harness than females; 
           - it is difficult to determine the true success rate for patients w/ clear cut DDH, since results published from tertiary care centers 
                   will be biased due to the large number of referred cases (referred because of treatment failures); 
           - other negative risk factors include: DDH in children older than 7 weeks, and hips which are not initially reducible; 
           - age greater than 6 mo is a contraindication due to worsening of impediments to reduction
                   - in these pts, harness may not produce reliabe reduction; pavlik
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