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Traction and Joint Reduction
Taken from the Children's and Women's Health Centre of British Colombia website.
"Traction and joint reduction is used if:
The Pavlik Harness fails to keep the hip in the joint,
the hip is too unstable to be managed with the harness,
if the instability is detected at a later age.
Joint reduction is done under a general anaesthetic. After the reduction, a cast is applied to hold the hips in joint.
It is not always possible to bring the head of the femur back into the socket easily. The muscles and ligaments that hold the head of the bone outside the hip socket are tight and may resist efforts to reposition the bone. The tightness must be overcome by prolonged, steady stretching. This is achieved through a process called traction.
Traction means applying weights on a pulley system to the limb so that the tight muscles are gradually stretched allowing the head of the femur to return to the hip socket. Special tape is applied to the child's legs, which are then wrapped with elastic bandages. Ropes and weights are attached to the tapes on the child's legs. The child is then positioned at an angle with head below hips. Both legs are placed in traction to provide balance. Different weight loads may be attached, however.
Traction looks strange but it does not hurt the child. The child will be uncomfortable and upset by the change for the first few days and may cry and fret but will soon become accustomed to it. Try to offer comfort anyway you know how - pats, songs, stories, a cuddly toy or special blanket help, but be prepared for a few days of unhappiness.
CARING FOR A CHILD IN TRACTION
Feeding: If you are breast feeding you can continue. Experiment until you find a way to rest your elbow on the crib mattress and position your breast. Ask the Nurse.
Skin Care: Skin care is important to prevent sores from developing. Either you or the nurse will check the skin every 2-4 hours for redness, rashes or rough patches. Check particularly the buttocks, shoulders and heels. If you notice any redness, gently massage the area. A little lotion on your hand will reduce the friction. You can turn the child onto the side for a short period to do the skin check.
Circulation: Because the child's legs are wrapped with bandages, we need to check blood circulation to the feet. They should be a normal pink colour and warm to touch. If you notice swelling or a change in colour or temperature, tell the nurse.
General Hygiene: Brush your child's hair 2-3 times a day to prevent tangles. You, or the nurse, should sponge bath your child each day and change the bedding. Ask the nurse for help with a bed change.
If baby is in diapers, change them right away when wet or soiled. Notify the nurse of any sign of constipation.
Maintaining traction is important to achieve steady stretching.
Don't remove your child from traction without specific instructions to do so.
Check that:
Weights are hanging free. If they are resting on something they are not providing any pull;
Ropes are in the pulleys;
Bandages are in place.
Try to provide as much stimulation as possible during this time.
JOINT REDUCTION
After a period of seven to ten days in traction, an x-ray is usually taken to ensure that the bones are correctly positioned. The doctor then manipulates the bones to ensure that the head of the femur is secure within the hip socket. This is called a closed reduction and is done with the baby under a general anaesthetic. Very often the groin tendon is tight and must be released. This is done when the baby is still under anaesthetic. It involves making a very small cut through the skin in the groin area and lengthening the tendon. No stitches are required for this. The incision heals very quickly.
A hip spica cast is then applied. This cast maintains the legs in a position bent up and out to the side. The cast remains on for several months. It will need changing every two to three months as the child grows. Cast changes are usually done under a general anaesthetic in daycare surgery.
Very occasionally, the hips cannot be properly repositioned in the hip socket during a closed reduction. Surgery is then necessary. This is known as an open reduction. Ligaments are cut to enable the head of the femur to be positioned within the joint. The operation usually lasts about one hour. A blood transfusion is not required. The baby wakes up in the recovery room in a hip spica cast. This cast remains on for approximately six weeks.
CDH needs to be monitored until the child has completed her growth. Initially you will be making frequent visits to the doctor. This need will decrease as the child gets older. At each visit the child's hips will be x-rayed to ensure normal, healthy development."
