Pavlik harness: Position for Reduction & Safe Zone

- Discussion:
    - stable zone:
          - ROM in which hip remains reduced w/o subluxation;
          - spica cast:
                 - may be used when reduction has narrow stable zone or when non-compliance w/ harness has been a problem;
    - safe zone:
          - arc of motion thru which hip remains reduced w/o forced abduction;
          - position that does not compromise blood supply to femoral head or create excessive pressure on the epiphysis;
          - stable zone should not exceed safe zone;
          - if a reduction cannot be maintained in the safe zone (ie, the hip must be placed into severe hyperflexion, internal rotation, or abduction > 70 deg) then operative reduction is indicated;
          - remember that a percutaneous adductor tenotomy can be used to increase the safe zone;
          - flexion safe zone:
                 - generally the safe zone is within 100 to 110 deg;
                 - flexion should be more than 90 but less than 120 deg;
                 - excessive flexion may result in femoral nerve palsy or fixed posterior dislocation;
                 - insufficient hip flexion, however, is most common pitfall;
                 - hips should be flexed 105-120 deg
                 - x-rays should be taken confirming adequacy of flexion in harness within 2-3 wks of application;
          - abduction safe zone:
                 - safe zone lies between 40 to 60 deg;
                 - avoid wide abduction which is associated w/ AVN;
                 - percutaneous release of adductor longus may facilitate reduction when passive abduction is < 70 degrees

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, August 9, 2012 1:58 pm