Guided abduction traction in the treatment of congenital hip dislocation.

Guided abduction is a form of overhead traction conceptually similar to the Pavlik harness. It is used in older children or in children in which the Pavlik harness has failed. The results of 27 congenitally dislocated hips treated by guided abduction traction from December 1979 to June 1989 were reviewed. Ages ranged from 1 month to 28 months. Twenty (74%) of the 27 hips underwent a gentle, often spontaneous, closed reduction, followed by abduction casting and bracing. Two hips developed radiographic evidence of avascular necrosis; five hips developed temporary irregular ossification. Closed reduction was unobtainable in any child older than 24 months. Two children needed additional reconstructive procedures, one an innominate pelvic osteotomy and the other a valgus derotation osteotomy. Both had had open reductions. Recent reports stated that preliminary traction in the treatment of congenitally dislocated hips is of no value. We consider guided abduction traction a valuable treatment modality resulting in a reduced incidence of open reduction. When comparing our results with those of a Salt Lake City study performed without preliminary traction, our incidence of open reduction is lower (26 versus 49%). Our study supports the use of preliminary traction to decrease the need for open reduction in congenitally dislocated hips.