Module 32, General Orthopaedist Level

A two month old child had been treated with a Pavlik Harness for a dislocated hip since age of 10 days. After 2 months, the left hip remained dislocated. Home traction was started. An arthrogram, adductor tenotomy and closed reduction was done at 4 months of age. Single hip spica was applied with the hip in 40 degrees of abduction and 100 degrees of flexion. Four months later, the spica cast was removed and an Atlanta brace was applied. X-rays showed avascular necrosis (AVN) at ten months of age.

Question 32A

The AVN at this age has a very bad prognosis and the parents should be informed that it will may lead to early degenerative joint disease(DJD).

Question 32B

With the presence of the AVN the primary goal for treatment is to keep the hip located and stable.

Question 32C

This hip will likely end up with a severe limb length discrepancy.

Question 32D

Short femoral neck with the frequent need for greater trochanteric epiphysiodesis should be expected.

Question 32E

The AVN was most likely caused by the early use of the Pavlik harness.

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