RADIOLOGICAL AND FUNCTIONAL OUTCOMES OF CLOSED REDUCTION AND ARTHROGRAPHY FOLLOWED BY HIP SPICA IN DEVELOPMENTAL DYSPLASIA OF THE HIP IN CHILDREN UNDER 18 MONTHS

Abstract

Background: Developmental dysplasia of the hip (DDH) is a common pediatric condition where early diagnosis and treatment are essential to prevent long-term disability. Closed reduction with arthrography followed by hip spica is widely used for children under 18 months, but local outcome data are limited.

Objective: To evaluate the radiological and functional outcomes of closed reduction with arthrography and hip spica in children under 18 months with DDH.

Methods: This descriptive case series was conducted in the Orthopedic Department of Khyber Teaching Hospital, Peshawar. A total of 336 children (<18 months) underwent closed reduction under anesthesia, confirmed by arthrography, followed by hip spica casting. Patients were followed for six months. Radiological outcomes were assessed using Severin’s classification, functional outcomes using Modified McKay’s criteria, and complications using Steinberg staging for avascular necrosis (AVN).

Results: The mean age was 5.61 ± 2.25 months; 73% were female. At six months, 69.9% of hips were Severin Type I and 19.3% Type II. Functionally, 58.9% achieved excellent and 30.9% good outcomes. AVN occurred in 2.38% of patients, limited to Stage 4. No significant differences were observed across age subgroups.

Conclusion: Closed reduction with arthrography and hip spica in infants under 18 months yields excellent radiological and functional results with a low risk of AVN. Early intervention, careful technique, and standardized casting can optimize outcomes. Longer follow-up is needed to evaluate late dysplasia and complications.