Comparative long-term outcomes of Petit-Morel versus overhead traction methods versus immediate closed reduction for late-detected developmental dysplasia of the hip: A systematic review

• Published in: Journal of children's orthopaedics Vol. 18; no. 6; pp. 590 - 599
• Main Authors: Duan, Lian, Canavese, Federico, Zhou, Weizheng, Chen, Yufan, Li, Lianyong
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.12.2024; Sage Publications Ltd
• Subjects: Closed reduction; Necrosis; Systematic Review; Developmental dysplasia of the hip; Petit-Morel technique; avascular necrosis; overhead traction
• ISSN: 1863-2521; 1863-2548
• DOI: 10.1177/18632521241265603

Purpose: This study aimed to compare the clinical and radiographic outcomes of traction to assist reduction in patients with late-detected developmental dislocation of the hip using the Petit-Morel technique versus the Bryant overhead traction technique, and to compare the clinical and radiographic outcomes of these two traction techniques with immediate closed reduction. Methods: A comprehensive systematic search of the MEDLINE/PubMed, EMBASE, and Web of Science databases was performed to identify relevant studies. Studies on Petit-Morel and overhead traction techniques and immediate closed reduction were then screened, selected, and data collected; included studies were assessed using the Methodological Index for Non-Randomized Studies criteria. Results: In total, 22 studies met the inclusion criteria. The Petit-Morel group had a successful reduction rate of 87% while the overhead traction group had a successful reduction rate of 67.1%, and the immediate closed reduction group had a successful reduction rate of 78.4% (Petit-Morel versus overhead traction, p < 0.001; overhead traction versus immediate closed reduction, p < 0.001, Petit-Morel versus immediate closed reduction, p = 0.021). The Petit-Morel group had an overall avascular necrosis rate of 2.7%, compared to 10.6% for overhead traction and 21.5% for immediate closed reduction (Petit-Morel versus overhead traction, p = 0.001; Petit-Morel versus immediate closed reduction, p < 0.001; overhead traction versus immediate closed reduction, p < 0.001). The Petit-Morel group achieved a satisfaction rate of 86.4% according to the Severin classification, as compared to 71.2% in the overhead traction group and 76.4% in the immediate closed reduction group (Petit-Morel versus overhead traction, p < 0.001; Petit-Morel versus immediate closed reduction, p = 0.018; overhead traction versus immediate closed reduction, p = 0.195). Conclusion: Petit-Morel and overhead traction techniques did not outperform immediate closed reduction in terms of redislocation rates, and radiological satisfaction, the Petit-Morel technique, has lower clinically significant avascular necrosis rates than overhead traction and immediate closed reduction. Level of evidence: Level III.