Warning to Public! The following videos contain graphic images of actual surgery. Viewer discretion is advised.
New Protocol for Older Infants May Avoid Cast or Surgery
Applying and adjusting the Pavlik Harness
Learning the Pavlik
The Pavlik harness has become the mainstay for treatment of children with developmental dysplasia of the hip. The harness is relatively easy to apply and adjust, but still requires some specialist skills. Given the length of time many children remain in the harness, parents also need to be able to feel comfortable with its use. Commenting that educational programs for the most part focus on operative techniques, the paediatric group in Toronto (Canada) set out to establish a consensus on how best to evaluate the application of the Pavlik harness in addition to the development of a competency-based assessment tool. The tool itself was developed after applying a Delphi process to ten experts, and using the results of this process to produce an objective structured assessment of technical skill with 25 items. A video-based validation exercise suggested that there was excellent consensus on the use of this tool, with a test-retest reliability of 0.98 and an intra-class correlation co-efficient of 0.96. The study group then went on to use the scoring template to assess three groups of users: novice (parents), intermediate (junior residents) and experts (staff surgeons, fellows and orthotists). They found the assessment tool to be a reliable and valid method for assessing Pavlik harness application and the expertise of the user (https://links.lww.com/BPO/A42). This is a useful document to review your own knowledge base and gives an excellent structured framework for assessing and teaching trainees and allied health in the application of the Pavlik harness.
View the complete article here: Pavlik Harness Learning Module
Video of Arthrogram, Closed Reduction and Cast Application
Review of Closed and Open DDH Treatment
Featuring Dennis R. Wenger, M.D. & Stuart L. Weinstein, M.D.
Additional thanks to Video Journal of Orthopaedics.