Abstract
Background and purpose
Avascular necrosis (AVN) is one of the common complications after closed reduction and hip spica cast for developmental dysplasia of the hip (DDH). Prereduction traction has been used to reduce a dislocated hip or decrease the risk of AVN, but there are conflicting results in prevention effects on AVN. The purpose of this study was to systematically review the current literature and evaluate the effect of prereduction traction in preventing AVN in children with DDH treated by closed reduction through a meta-analysis.
Materials and methods
A systematic review of the literature was performed using PubMed and EMBASE with variations of three major terms: 1) hip dislocation; 2) closed reduction; and 3) avascular necrosis. Seven studies that could compare the incidence of AVN between the traction and no-traction group were included. Methodological quality was assessed, a heterogeneity test was done (p=0.008), and the pooled risk ratios were estimated.
Results
The association between traction and AVN was assessed, using data on 683 hips treated by closed reduction. The incidence of AVN in the traction and no-traction groups ranged from 5% to 47.7% and from 0% to 72.7%, respectively. A meta-analysis with a random effects model indicated no significant difference in the incidence of AVN between traction and no-traction groups (p=0.536).
Conclusion
There was insufficient evidence to decide the efficacy of prereduction traction before closed reduction in reducing the risk of AVN in patients with DDH in this meta-analysis. To recommend prereduction traction for the prevention of AVN, long-term follow-up studies considering age, severity of dislocation, and appropriate traction method are needed.
Supplementary materials
Figure S3 Bucholz and OgdenCitation1 classification.
![Figure S3 Bucholz and OgdenCitation1 classification.](/cms/asset/ab12bf04-c81b-4296-8f47-03f6e905be5c/dtcr_a_166531_sf0003_b.jpg)
Reference
- BucholzRWOgdenJAPatterns of ischemic necrosis of the proximal femur in nonoperatively treated congenital hip diseaseThe Hip: Proceedings of the Sixth Open Scientific Meeting of the Hip SocietySt. Louis, MOMosby19784363
Acknowledgments
The authors wish to thank Hyun Woo Kim for his advice and Sungmin Kim for his help with the statistical analysis. This study was supported by a faculty research grant of Yonsei University College of Medicine (6-2017-0095).
Author contributions
KBP and YHK conceived and designed this research. VNV and KBP acquired the data. HS did a statistical analysis. KBP revised the manuscript. All authors read and approved the final manuscript. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.