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The study aim is to compare clinical and radiological outcomes of 6-week versus 12-week hip spica immobilization following open reduction and pelvic osteotomy for DDH.
Developmental dysplasia of the hip (DDH) is a common pediatric orthopedic disorder with a prevalence of 2% to 3% in neonates. Surgical intervention, including open reduction and pelvic osteotomy, is indicated when closed reduction fails or diagnosis is delayed. Traditionally, postoperative immobilization in a hip spica cast is recommended for 12 weeks to maintain stability. However, recent studies suggest that shorter durations (6 weeks) may provide equivalent stability with fewer complications such as joint stiffness, muscle atrophy, skin breakdown, and caregiver burden. some fractures occurs after the cast, according to Alassaf 2018 out of total of 128 patients (162 hips) 93 were in the double-leg spica group, and 69 were in the single-leg spica group three patients had a greenstick distal femur fracture after double-leg spica and one after single-leg spica. There is no international consensus on the optimal spica duration, and evidence is limited. Proving that 6 weeks immobilization is not inferior to 12 weeks immobilization could improve outcomes, reduce costs, and lessen morbidity.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 6-week spica group | Experimental | Patients will undergo open reduction and pelvic osteotomy for DDH, followed by immobilization in a hip spica cast for 6 weeks. |
|
| 12-week spica group | Experimental | Patients will undergo open reduction and pelvic osteotomy for DDH, followed by immobilization in a hip spica cast for 12 weeks. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| hip spica immobilization for 6 weeks | Procedure | Patients undergo open reduction and pelvic osteotomy for DDH followed by hip spica cast immobilization for 6 weeks. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Redislocation rate | Incidence of hip redislocation within the first 12 months after open reduction and hip spica immobilization. | 12 months post-surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Radiological outcomes | Assessment of acetabular index and femoral head position using pelvic X-rays at follow-up | 3, 6, and 12 months post-surgery |
| Functional outcomes | Time to independent ambulation and hip joint range of motion assessment. |
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Inclusion Criteria:
Exclusion Criteria:
• Infection
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Participants will be randomized into two parallel groups to receive either 6 weeks or 12 weeks of hip spica immobilization following open reduction for developmental dysplasia of the hip (DDH)
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| hip spica immobilization for 12 weeks | Procedure | Patients undergo open reduction and pelvic osteotomy for DDH followed by hip spica cast immobilization for 12 weeks. |
|
| Within 6-12 months post-surgery |
| Complications | Occurrence of cast-related problems including skin sores, pressure ulcers, and cast intolerance. | During immobilization period and up to 3 months post-cast removal |