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Cochrane Database of Systematic Reviews

Splinting for the non‐operative management of developmental dysplasia of the hip (DDH) in children under six months of age

Information

DOI:
https://doi.org/10.1002/14651858.CD012717.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 10 October 2022see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:

  1. Cochrane Developmental, Psychosocial and Learning Problems Group

Copyright:
  1. Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Kerry Dwan

    Correspondence to: Editorial & Methods Department, Cochrane Central Executive, London, UK

    [email protected]

  • Jamie Kirkham

    Centre for Biostatistics, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK

  • Robin W Paton

    East Lancashire Hospitals NHS Trust, Burnley, UK

    School of Medicine, University of Central Lancashire, Preston, Lancashire, UK

  • Emma Morley

    Parent Co-investigator, Warrington, UK

  • Ashley W Newton

    Health Education North West (Mersey), Liverpool, UK

  • Daniel C Perry

    Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK

    Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK

    Department of Orthopaedic Surgery, Alder Hey Hospital, Liverpool, UK

Contributions of authors

Conception of the review; KD, JK and DP

Design of the review: KD and DP

Co‐ordination of the review: KD

Search and selection of studies for inclusion in the review: KD, DP, JK and AN

Collection of data for the review; KD, DP, JK, AN

Assessment of the risk of bias in the included studies; KD, DP, JK, AN

Analysis of data; KD

Assessment of the certainty in the body of evidence; KD, DP

Interpretation of data; DP, AN

Writing of the review: all authors

Sources of support

Internal sources

  • Cochrane, UK

    KD worked on this review during work time.

  • University of Manchester, UK

    JK worked on this during work time

External sources

  • National Institute of Health Research (NIHR), UK

    Daniel C Perry is funded as an NIHR Clinician Scientist.

  • Steps, UK

    Steps fund Emma Morley.

Declarations of interest

KD is a Statistical Editor with the Cochrane Editorial and Methods Department.

JK: has declared that he has no conflicts of interest.

RP was a Consultant Orthopaedic Surgeon with East Lancashire Hospitals NHS Trust, Blackburn, at the time this review was written; he has since retired (as of 27 April 2022). He is a member of the British Society for Children's Orthopaedic Surgery, and was an elected Council Member (five‐year appointment from 2016 to 2021) and Trustee of the Royal College of Surgeons of Edinburgh (a registered charity), where he was involved in postgraduate education and various faculties and examinations in the College, and received in‐kind support; unpaid positions. RP was awarded the King James IV Professorship from the Royal College of Surgeons of Edinburgh for 2016/17, and reports fees and an honorarium for a lecture on 'screening in DDH', presented at the British Orthopaedic Association in Belfast in 2016, which he gave as part of this award; personal payment. RP also reports an honorarium and travel expenses from the Chinese University of Hong Kong in March 2019 for being an external assessor for the surgical finals; travel and hotel expenses from East Lancashire Hospitals NHS Trust, to attend the British Society for Children's Orthopaedics in March 2017; and travel and hotel expenses from the Royal College of Surgeons of Edinburgh, to attend council meetings and other college committees; all personal payments. In addition, RP reports fees for expert testimony from a private, medio‐legal practice on trauma until December 2015, for four supplementary medico‐legal reports and a medico‐legal report on DDH; and fees for 'ad hoc' consultancy services (1 May 2020 to the 30 April 2021), to review the orthopaedic aspects of basic science research and to interpret the clinical aspects of stage III trials on a possible injection treatment for osteo‐arthritis of the knee for a pharmaceutical company (this did not involve the hip joint, children or developmental dysplasia of the hip); all personal payments. RP's main research interest is in screening for DDH, and he has published many peer reviewed articles and a PhD (2011, University of Lancaster). He was involved in the following, unfunded studies, all of which were retrospective analyses of ongoing prospective research data that had been approved by the ethics and research department at the East Lancashire Hospitals NHS Trust where they were undertaken, and which were eligible for inclusion in this review: 1) Paton RW, Hopgood PJ, Eccles C. Instability of the neonatal hip: the role of early or late splintage. International Orthopaedics. 2004;38(5):270‐3; 2) Sampath JS, Deakin S, Paton RW. Splintage in developmental dysplasia of the hip. How low can we go? Journal of Pediatric Orthopedics. 2003;23(3):352‐5; 3) Paton RW, Paniker J. Comment on 'The efficacy of the Pavlik Harness, the Craig splint ad the von Rosen splint in the management of neonatal dysplasia of the hip. PMID: 14516053'. Journal of Bone and Joint Surgery. 2003; 85‐B(7):1086. PMID: 14516054. RP was not involved in assessing eligibility, extracting data, assessing risk of bias or grading the certainty of the evidence from the study included in this review. RP is an unpaid, peer reviewer for the following journals: 'The Surgeon'; 'The Knee'; 'The Bone & Joint Journal' and 'The Journal of Paediatrics'.

EM: reports travel and time‐related expenses from Steps Charity, for attending meetings related to the BOSS (British Orthopaedic Surgery) study and the Newborn and Infant Physical Examination (NIPE) Advisory Board were she served as a patient advocate through her work at Steps Charity specialising in DDH detection; personal payment. EM is involved with the Newborn and Infant Physical Examination Board. Previously employed by Steps Charity Worldwide ‐ a charity offering to support for families of children affected by lower limb conditions.

AN: has declared that he has no conflicts of interest.

DP: reports grants from the National Institute of Health Research, Arthritis Research UK, and Perthes' Association and Medtronic for work pertaining to diseases of children's orthopaedics; paid to the University of Oxford. DP also reports a US $10k travelling fellowship from the British Society of Children's Orthopaedic Surgery for research development, which was indirectly funded by Orthopediatrics; paid to the University of Oxford. DP is the National Clinical Advisor to the Hip Screening Programme within Public Health England.

Acknowledgements

We thank Margaret Anderson for constructing the search strategy, and Lucia Martinkovicova and Edyta Ryczek for translating two of the studies. We would also like to acknowledge CDPLPG for their help and support throughout the review process.

The CRG Editorial Team are grateful to the following peer reviewers for their time and comments: Dr Alexander Aarvold, Southampton Children’s Hospital, UK; and Dr David Osborn, University of Sydney, Australia; and to Lindsay Robertson for copyediting this review.

Version history

Published

Title

Stage

Authors

Version

2022 Oct 10

Splinting for the non‐operative management of developmental dysplasia of the hip (DDH) in children under six months of age

Review

Kerry Dwan, Jamie Kirkham, Robin W Paton, Emma Morley, Ashley W Newton, Daniel C Perry

https://doi.org/10.1002/14651858.CD012717.pub2

2017 Jul 04

Splinting for the non‐operative management of developmental dysplasia of the hip (DDH) in children under six months of age

Protocol

Kerry Dwan, Jamie Kirkham, Robin W Paton, Emma Morley, Ashley William Newton, Daniel C Perry

https://doi.org/10.1002/14651858.CD012717

Differences between protocol and review

  1. When screening studies for inclusion, the review authors noted that studies conducted before 1980 should be excluded as ultrasound was only introduced in 1980 and, as described in the Description of the condition section, decisions regarding the treatment of DDH are typically made based on the ultrasonographic appearance of the hips. This has now been explicitly included under Types of studies.

  2. We did not search DARE in 2020 because no new content was added to this database since 2015.

  3. ProQuest Dissertations & Theses A&I became available to us in 2020, and this was searched instead of Networked Digital Library of Theses and Dissertations (NDLTD).

  4. We included the post hoc comparison 'staged weaning versus immediate removal' because it was decided that this was an important comparison. This is because practice varies, even across the UK, as there was no evidence for this and when the study was identified we realised that we had not been clear about including this. It was an oversight in the protocol and is needed to inform practice.

  5. We now refer to certainty of the evidence rather than quality of the evidence, in line with current guidance.

  6. We were unable to use all of our preplanned methods (Dwan 2017), which have been archived for use in future updates of this review (Appendix 2).

  7. We did not assess other risks of bias.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Child; Female; Humans; Infant;

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

PRISMA flow diagram

Figures and Tables -
Figure 1

PRISMA flow diagram

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Risk of bias plot for RCTs

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Figure 2

Risk of bias plot for RCTs

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ROBINS‐I plot: acetabular index at one year

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Figure 3

ROBINS‐I plot: acetabular index at one year

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ROBINS‐I plot: Need for surgical open reduction

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Figure 4

ROBINS‐I plot: Need for surgical open reduction

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Comparison 1: Dynamic splinting versus delayed or no splinting, Outcome 1: Acetabular index: angle (RCTs)

Figures and Tables -
Analysis 1.1

Comparison 1: Dynamic splinting versus delayed or no splinting, Outcome 1: Acetabular index: angle (RCTs)

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Comparison 1: Dynamic splinting versus delayed or no splinting, Outcome 2: Acetabular index: angle (non RCTs)

Figures and Tables -
Analysis 1.2

Comparison 1: Dynamic splinting versus delayed or no splinting, Outcome 2: Acetabular index: angle (non RCTs)

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Comparison 1: Dynamic splinting versus delayed or no splinting, Outcome 3: Need for operative intervention

Figures and Tables -
Analysis 1.3

Comparison 1: Dynamic splinting versus delayed or no splinting, Outcome 3: Need for operative intervention

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Comparison 1: Dynamic splinting versus delayed or no splinting, Outcome 4: Avascular necrosis

Figures and Tables -
Analysis 1.4

Comparison 1: Dynamic splinting versus delayed or no splinting, Outcome 4: Avascular necrosis

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Comparison 2: Static splinting versus delayed or no splinting, Outcome 1: Acetabular index: angle ≥ 28° (non‐RCTs)

Figures and Tables -
Analysis 2.1

Comparison 2: Static splinting versus delayed or no splinting, Outcome 1: Acetabular index: angle ≥ 28° (non‐RCTs)

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Comparison 2: Static splinting versus delayed or no splinting, Outcome 2: Need for operative intervention (non‐RCTs)

Figures and Tables -
Analysis 2.2

Comparison 2: Static splinting versus delayed or no splinting, Outcome 2: Need for operative intervention (non‐RCTs)

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Comparison 3: Dynamic splinting versus static splinting, Outcome 1: Acetabular index: angle ≥ 28° (non RCTs)

Figures and Tables -
Analysis 3.1

Comparison 3: Dynamic splinting versus static splinting, Outcome 1: Acetabular index: angle ≥ 28° (non RCTs)

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Comparison 3: Dynamic splinting versus static splinting, Outcome 2: Acetabular index:angle (non‐RCTs)

Figures and Tables -
Analysis 3.2

Comparison 3: Dynamic splinting versus static splinting, Outcome 2: Acetabular index:angle (non‐RCTs)

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Comparison 3: Dynamic splinting versus static splinting, Outcome 3: Need for operative intervention (non RCTs)

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Analysis 3.3

Comparison 3: Dynamic splinting versus static splinting, Outcome 3: Need for operative intervention (non RCTs)

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Comparison 4: Staged weaning versus immediate removal (post hoc comparison), Outcome 1: Acetabular index: angle (non‐RCT)

Figures and Tables -
Analysis 4.1

Comparison 4: Staged weaning versus immediate removal (post hoc comparison), Outcome 1: Acetabular index: angle (non‐RCT)

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Comparison 4: Staged weaning versus immediate removal (post hoc comparison), Outcome 2: Need for operative intervention to achieve reduction (non‐RCTs)

Figures and Tables -
Analysis 4.2

Comparison 4: Staged weaning versus immediate removal (post hoc comparison), Outcome 2: Need for operative intervention to achieve reduction (non‐RCTs)

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Comparison 4: Staged weaning versus immediate removal (post hoc comparison), Outcome 3: Need for operative intervention to address dysplasia (non‐RCTs)

Figures and Tables -
Analysis 4.3

Comparison 4: Staged weaning versus immediate removal (post hoc comparison), Outcome 3: Need for operative intervention to address dysplasia (non‐RCTs)

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Comparison 4: Staged weaning versus immediate removal (post hoc comparison), Outcome 4: Avascular necrosis (non‐RCTs)

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Analysis 4.4

Comparison 4: Staged weaning versus immediate removal (post hoc comparison), Outcome 4: Avascular necrosis (non‐RCTs)

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Summary of findings 1. Dynamic splinting versus delayed or no splinting for the non‐operative management of developmental dysplasia of the hip in babies under six months of age

Dynamic splinting versus delayed or no splinting for the non‐operative management of developmental dysplasia of the hip in babies under six months of age

Patient or population: babies under six months of age with all severities of DDH
Setting: hospital
Intervention: dynamic splinting
Comparison: delayed or no splinting

Outcomes

№ of babies

(Studies)
Follow up

Certainty of the evidence (GRADE)

Impact

Measurement of acetabular index at 1 year 
Assessed with: radiographs (angle)

265
(2 RCTs)

⊕⊝⊝⊝
Very lowa,b

One study (stable hips) presented data at one year (MD 0.10, 95% CI −0.74 to 0.94), accounting for correlated observations from hips from the same baby. Another study (stable hips) reported an MD 0.20 (95% CI −1.65 to 2.05) but did not take into account hips from the same baby in the case of bilateral hip dysplasia, so the data were not combined.

Measurement of acetabular index at 2 years 
Assessed with: radiographs (angle)

181
(2 RCTs)

⊕⊝⊝⊝
Very lowa,b

One study (stable hips) reported a MD −1.90(95% CI −4.76 to 0.96). Another study (stable hips) reported an MD ‐0.10 (95% CI −1.93 to 1.73) but did not take into account hips from the same baby in the case of bilateral hip dysplasia, so the data were not combined.

Measurement of acetabular index at 5 years 
Assessed with: radiographs (angle)

0
(0 RCTs)

‐

No studies reported data at this time point.

Need for operative intervention at study follow up (range 12 weeks to 1 year)

434
(4 RCTs)

⊕⊝⊝⊝
Very lowa,b

Three studies reported no surgical intervention. In a further study, two babies developed instability in the Pavlik harness group and were subsequently treated with closed reduction and spica cast. It is not explicitly stated if this was to achieve concentric reduction or address residual dysplasia.

Complications: avascular necrosis and femoral nerve palsy at study follow up (range 12 weeks to one year)

Assessed with: grading systems (not stated)

390
(3 RCTs)

⊕⊝⊝⊝
Very lowa,b

One study found that "over the period of follow‐up, no complications of treatment were observed, and none of the children developed abnormal clinical findings on hip examination." One study reported no avascular necrosis in either group and another study reported no femoral nerve palsy in either group.

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; DDH: developmental dysplasia of the hip; MD: mean difference; RCT: randomized controlled trial

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect
Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect

aWe downgraded the certainty of the evidence by one level for risk of bias, as studies were at high or unclear risk of bias for selective reporting, sequence generation, allocation concealment and blinding due to limited details reported in the trial reports, and high risk of bias due to incomplete outcome data.
bWe downgraded the certainty of the evidence by two levels for imprecision, due to the small number of included studies and babies

Figures and Tables -
Summary of findings 1. Dynamic splinting versus delayed or no splinting for the non‐operative management of developmental dysplasia of the hip in babies under six months of age
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Summary of findings 2. Dynamic splinting versus static splinting for the non‐operative management of developmental dysplasia of the hip in babies under six months of age

Dynamic splinting versus static splinting for the non‐operative management of developmental dysplasia of the hip in babies under six months of age

Patient or population: babies under six months of age with stable and unstable hips
Setting: hospitals
Intervention: dynamic splinting
Comparison: static splinting

Outcomes

№ of babies

(studies)

Certainty of the evidence
(GRADE)

Impact

Measurement of acetabular index at 1 year

Assessed with: radiographs (angle)

0

(0 RCTs)

‐

No data presented and it is unclear if the outcome was measured.

Measurement of acetabular index at 2 years

Assessed with: radiographs (angle)

0

(0 RCTs)

‐

No data presented and it is unclear if the outcome was measured.

Measurement of acetabular index at 5 years

Assessed with: radiographs (angle)

0

(0 RCTs)

‐

No data presented and it is unclear if the outcome was measured.

Need for operative intervention

0

(0 RCTs)

‐

No data presented and it is unclear if the outcome was measured.

Complications: avascular necrosis at 4 months

Assessed with: grading systems (not stated)

118 hips

(1 RCT)

⊕⊝⊝⊝
Very lowa,b

One RCT reported no occurrence of avascular necrosis in either group.

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; DDH: developmental dysplasia of the hip; RCT: randomized controlled trial

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect
Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect

aWe downgraded the certainty of the evidence by one level for risk of bias, as we judged risk of bias as generally unclear in all domains except incomplete outcome data, due to limited details reported in the trial report.
bWe downgraded the certainty of the evidence by two levels for imprecision, due to there only being one small study.

Figures and Tables -
Summary of findings 2. Dynamic splinting versus static splinting for the non‐operative management of developmental dysplasia of the hip in babies under six months of age
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Table 1. ORBIT matrix

Study

Measurement of acetabular index

Need for operative intervention

Avascular necrosis

Femoral nerve palsy/other nerve palsies

Pressure areas on skin

Health economic assessment

Bonding between parents and child

Motor skill development

Other outcomes

Azzoni 2011

x

Reported

Reported

x

x

x

x

x

Time to recovery

Bergo 2013

x

x

x

x

x

x

x

x

Psychosocial outcomes, anxiety

Bram 2021

Reported

x

x

x

x

x

x

x

Time spent in harness

Gardiner 1990

x

Reported

Reported

x

x

x

x

x

Abnormal hips

Gou 2021

Reported

x

x

x

x

x

x

x

Success/ failure

Kim 2019

Reported

Reported

x

x

x

x

x

x

None

Laborie 2014

Measured

Reported

Reported

x

x

x

x

x

None

Larson 2019

x

Reported

x

x

x

x

Reported

x

Success/failure

Lee 2022

x

x

x

x

x

x

x

x

Alpha angle at 1 month, rate of improvement to Graf type I hips in 1
month, any problems or morbidities in the study period, and number of ultrasound examinations and orthopaedic
clinic visits in the first year

Lyu 2021

Reported

x

Reported

Reported

x

x

x

x

Time needed to achieve Graf type IIb

Munkhuu 2013

x

x

x

x

x

x

x

x

Development of hips, complications

Murphy 2017

x

Partially reported

x

x

x

x

x

x

Resolution of dysplasia on subsequent imaging and failure of resolution or deterioration on subsequent imaging

Paton 2004

x

Reported

Reported

x

x

x

x

x

Late splintage

Pollett 2020

Reported

Reported

x

Reported

x

x

x

x

Bony roof angle, modifed tonnis classification

Ran 2020

Reported

Reported

Reported

Reported

x

x

x

x

Failure/ success, center‐edge angle

Reikerås 2002

Reported

x

x

x

x

x

x

x

Provokable instability, beta angles

Rosendahl 2010

Reported

NA

Reported

Reported

Reported

x

x

x

None

Sucato 1999

Reported

x

x

x

x

x

x

x

None

Upasani 2016

Partially reported

Reported

Reported

Reported

x

x

x

x

Osteonecrosis

Westacott 2014

Reported

Reported

Rreported

x

x

x

x

x

Retreatment, other complications, successful treatment

Wilkinson 2002

x

Reported

Reported

x

x

x

x

x

Number with acetabular angle ≥ 28°; improvement on ultrasound; further treatment with an abduction plaster; deformaties

Wood 2000

Reported

Reported

x

x

x

x

x

x

Acetabular cover
Figures and Tables -
Table 1. ORBIT matrix
Navigate to table in Review
Table 2. ROBINS‐I

Bias domain

Bias due to confounding

Bias in selection of participants into the study

Bias in the classification of interventions

Bias due to departures from intended interventions

Bias due to missing data

Bias in measurement of outcomes

Bias in selection of the reported result

Overall

Acetabular index at one year

Bram 2021

Serious

Moderate

Low

Moderate

Serious

Moderate

Moderate

Serious

Kim 2019

Moderate

No information

Low

Moderate

Moderate

Low

Moderate

Moderate

Murphy 2017

No information

Low

Low

No information

No information

Moderate

Moderate

Moderate

Paton 2004

Serious

Moderate

Low

Moderate

Moderate

Serious

Moderate

Serious

Sucato 1999

Low

Serious

Low

Moderate

Moderate

Moderate

Moderate

Serious

Upasani 2016

Low

Low

Low

Moderate

Moderate

Moderate

Moderate

Moderate

Wilkinson 2002

Serious

Moderate

Serious

No information

Moderate

Serious

Moderate

Serious

Need for surgical open reduction

Kim 2019

Moderate

No information

Low

Moderate

Moderate

Low

Moderate

Moderate

Laborie 2014

Critical

Low

Moderate

Low

Moderate

Moderate

Moderate

Critical

Larson 2019

Serious

Serious

Low

Moderate

Moderate

Moderate

Moderate

Serious

Murphy 2017

No information

Low

Low

No information

No information

Moderate

Moderate

Moderate

Paton 2004

Serious

Moderate

Low

Moderate

Moderate

Serious

Moderate

Serious

Ran 2020

Serious

Serious

Serious

Low

Serious

Low

Low

Serious

Upasani 2016

Low

Low

Low

Moderate

Moderate

Moderate

Moderate

Moderate

Wilkinson 2002

Serious

Moderate

Serious

No information

Moderate

Serious

Moderate

Serious
Figures and Tables -
Table 2. ROBINS‐I
Navigate to table in Review
Table 3. Dynamic splinting versus delayed or none

Study

Design

Intervention

Comparator

Bergo 2013

Cross‐sectional study

Early splinting (Frejka pillow)

Late splinting

Gardiner 1990

Quasi‐RCT

Immediate splinting

Sonographic surveillance for 2 weeks

Control

Kim 2019

Prospective

Pavlik

Observed

Laborie 2014

Observational

Abduction splint (Frejka splint): persistent dislocated or dislocatable

Watchful waiting: clinically or ultrasound unstable but not dislocatable hips

Larson 2019

Reterospective

Pavlik harness

Groups were divided based on the age at

which the Pavlik harness was initiated: group 1 = < 30 days; group 2 = 30 to 60 days; group 3 = > 60 days

Murphy 2017

Reterospective

Pavlik harness

Followed up without treatment

Paton 2004

Prospective

Early splinting (Pavlik)

Follow up with ultrasound

Pollett 2020

RCT

Pavlik harness

Active surveillance

Reikerås 2002

Babies 'divided' into 2 groups

Frejkas pillow for 16 weeks

Untreated

Rosendahl 2010

RCT

Immediate abduction splinting for at least 6 weeks (Frejka pillow splint with sonographic follow up)

Active sonographic surveillance but no treatment for 6 weeks

Sucato 1999

Reterospective review (observational)

Pavlik (chosen at the discretion of the treating physician)

No treatment

Wilkinson 2002

Retrospective

Pavlik

Not splinted

Wood 2000

RCT

Pavlik

No splint

RCT: Randomised controlled trial
Figures and Tables -
Table 3. Dynamic splinting versus delayed or none
Navigate to table in Review
Table 4. Static splinting versus delayed or none

Study

Design

Intervention

Comparator

Munkhuu 2013

Prospective cohort

Type 2c‐4: Tubingen hip flexion splint

Type 2a: ultrasound follow‐up

Wilkinson 2002

Retrospective

Craig; Von Rosen

Not splinted
Figures and Tables -
Table 4. Static splinting versus delayed or none
Navigate to table in Review
Table 5. Dynamic versus static splinting

Study

Design

Intervention

Comparator

Azzoni 2011

RCT

Static: Teuffel Mignon

Dynamic: Coxa‐flex

Gou 2021

Retrospective cohort

Static: Human Brace

Dynamic: Pavlik harness

Lyu 2021

Retrospective cohort

Static: Tubigen

Dynamic: Pavlik harness

Ran 2020

Retrospective cohort

Static: Tubigen

Dynamic: Pavlik harness

Upasani 2016

Prospective cohort

Static: brace treatment (Denis Browne, Von Rosen, Plastazote)

Dynamic: Pavlik harness

Wilkinson 2002

Retrospective cohort

Static: Craig; Von Rosen

Dynamic: Pavlik harness

RCT: randomised controlled trial
Figures and Tables -
Table 5. Dynamic versus static splinting
Navigate to table in Review
Comparison 1. Dynamic splinting versus delayed or no splinting

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Acetabular index: angle (RCTs) Show forest plot

4

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1.1 Six months

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1.2 One year

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1.3 Two years

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.2 Acetabular index: angle (non RCTs) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.2.1 Two years

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.3 Need for operative intervention Show forest plot

6

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.3.1 RCT

3

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.3.2 Prospective study

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.3.3 Retrospective study

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.4 Avascular necrosis Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.4.1 Quasi RCT

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.4.2 Prospective study

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.4.3 Retrospective study

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.4.4 Observational study

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Figures and Tables -
Comparison 1. Dynamic splinting versus delayed or no splinting
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Comparison 2. Static splinting versus delayed or no splinting

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Acetabular index: angle ≥ 28° (non‐RCTs) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.2 Need for operative intervention (non‐RCTs) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Figures and Tables -
Comparison 2. Static splinting versus delayed or no splinting
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Comparison 3. Dynamic splinting versus static splinting

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

3.1 Acetabular index: angle ≥ 28° (non RCTs) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.2 Acetabular index:angle (non‐RCTs) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.2.1 Less than 6 months

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.2.2 2 years

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.3 Need for operative intervention (non RCTs) Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.3.1 Prospective cohort

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.3.2 Retrospective study

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Figures and Tables -
Comparison 3. Dynamic splinting versus static splinting
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Comparison 4. Staged weaning versus immediate removal (post hoc comparison)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4.1 Acetabular index: angle (non‐RCT) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1.1 Hips with positive Ortolani sign

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1.2 Stable Hips

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.2 Need for operative intervention to achieve reduction (non‐RCTs) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.3 Need for operative intervention to address dysplasia (non‐RCTs) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.4 Avascular necrosis (non‐RCTs) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Figures and Tables -
Comparison 4. Staged weaning versus immediate removal (post hoc comparison)
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