Is Gallows traction effective before open reduction surgery for Developmental Dysplasia of the Hip?

Nic Uren, Julia Judd, Ed Lindisfarne, Kirsten Elliott, Alex Aarvold

University Hospital Southampton

Gallows traction is used before the surgical reduction of dislocate. Despite requiring extended hospital stays, traction theoretically reduces soft tissue tension, allowing an easier surgical reduction and thus fewer complications including re-dislocation and avascular necrosis. This study aims to quantify the effectiveness of Gallows traction at altering the resting position of the hip.

All infants less than 12kg treated with hip open reduction surgery undergo pre-operative gallows traction at our institution. Patients have a pre-traction radiograph, repeated pre-operatively in theatre with traction removed. The resting position of the hip before and after traction was compared in eighty consecutive patients using the IHDI classification system. The re-dislocation rate and the prevalence of clinically relevant AVN following our surgical protocol was calculated in a longer-term cohort (mean 8 years) of 100 patients.

Before traction, 49 hips were IHDI grade IV, 27 hips were grade III, and 4 hips were grade II. Following traction, 24 hips were grade IV, 37 hips were grade III, and 19 hips were grade II. There was a significant improvement in hip position according to IHDI classification (P < 0.001, Wilcoxon signed rank test). The outcomes in the longer-term cohort reported that only 2% of hips re-dislocated, and 94% of hips were a Severin 1 or 2 outcome (i.e. good or excellent).

This study found that pre-operative Gallows traction decreases the degree of hip displacement. Despite the practicalities of the regime, this study supports its use ahead of hip open reduction surgery.