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What are Pavlik Harness and Tübingen Splint for DDH?

The Pavlik harness and Tübingen splint are non-surgical treatment options employed in treating infants with developmental dysplasia of the hip (DDH). DDH is a developmental abnormality of the hip joint in which the “ball and socket" joint of the hip does not form properly in infants. The condition is most often noted at birth. However, it may also present during an infant’s first year of life.

The hip is a ball and socket joint with the head of the femur or thighbone as the ball and the pelvic acetabulum forming the socket. In a normal hip, the head of the femur fits firmly into the cup-shaped socket of the pelvic acetabulum. However, in infants and children with DDH, the socket of the acetabulum is too shallow and the femoral head is not held firmly in place, resulting in a loose hip joint. In severe cases, the femur or thigh bone can partially or completely slip out of the socket causing dislocation at the hip joint.

A Pavlik harness is a soft splint or a brace specially designed to position your infant’s knees and hips flexed (bent) and thighs abducted (spread apart) so that they are correctly aligned in the hip joint. This position allows the hips to develop properly and keep the hip joint secure.

A Tubingen splint is a hip flexion and abduction orthosis that helps to flex your infant's hip joints at an angle of 90 degrees or more and spreads them to a small degree. The splint aims at establishing the best possible position to make sure that your infant’s hip matures thoroughly without any issues.

Indications for Pavlik Harness and Tubingen Splint

The Pavlik harness and Tübingen splint are mainly indicated for the treatment of mild to moderate DDH in babies younger than 1 year of age and with a reducible hip (whose bones are still fairly soft).

Treatment with Pavlik Harness and Tubingen Splint

The Pavlik harness splint consists of several straps that secure your infant’s body firmly. It basically comprises leg straps and a chest strap. The chest strap travels across the infant’s back and extends around to cover the front. The leg straps attach to the anterior of the body strap, loop below each foot, cross over in the back, and connect to the top of the body strap. Each leg strap comprises 2 extra straps that wrap around the lower leg. The harness works by supporting the infant’s legs in an outward-rotated and bent posture. It prevents infants from straightening their legs and makes it difficult to bring their legs together. The flexible straps attached to the infant’s legs, trunk, and shoulders help to keep the ball of the hip joint in proper position inside the socket.

The Tubingen splint has a similar function as the Pavlik harness and is a reliable alternative treatment option for early diagnosed DDH. This splint is comprised of beaded cords and synthetic shells, which are variable in size. With the Tubingen splint, your infant’s hips are bent or flexed at more than 90 degrees whereas the legs are abducted or spread by more than 30 to 45 degrees. This positioning helps to keep the head of the femur in the socket, promote normal growth of the acetabulum, and enable surrounding joint ligaments to tighten.

Post Splint Placement Personal Care and Instructions

Your child’s physician may advise the following instructions for care and management of your baby with a Pavlik harness or Tübingen splint:

  • Your child needs to wear the splint full-time for at least 6 to 12 weeks.
  • Refrain from bathing your infant in a tub or shower. Use only sponge bathing.
  • Keep skin folds clean and dry, particularly diaper and knee areas.
  • Dress your child in loose clothing so as to provide better ventilation.
  • Ensure blankets or clothes do not bring your infant’s knees together.
  • Do not wrap or swaddle your infant in a traditional manner.
  • Do not adjust or remove the harness without your doctor’s consent.
  • Your nurse will instruct you on how to dress your baby without loosening or adjusting the straps of the splint.
  • When changing diapers, ensure that the diaper is properly locked under the straps.
  • Use a mild soap to wash the harness straps if they become soiled or dirty.
  • When your infant is fed and full, the strap across the chest may seem tight. You may loosen the strap for comfort for a short time and tighten it up later. Maintain a two-finger space between the chest strap and chest as standard.
  • A follow-up is scheduled with your doctor every week or two to monitor your child’s progress, adjust the fit, and screen for any complications associated with the splints.
  • A follow-up X-ray or ultrasound is also recommended to check the development of the hips with usage of the splints.

Risks and Complications

Some of the risks and complications associated with the Pavlik harness and Tübingen splint include:

  • Femoral  nerve palsy
  • Nerve damage in the shoulder or legs
  • Knee subluxation (partial dislocation)
  • Skin breakdown, especially behind the knee and in the groin
  • Avascular necrosis (death of bone tissue due to deficient blood supply)
  • Downward hip dislocation
  • Flattening of the rear of the femoral head
  • Failure of the treatment

When Should You Call Your Doctor?

You need to seek your doctor’s attention if you experience any of the following issues:

  • Your infant’s feet appear puffy and swollen despite loosening the Velcro straps
  • Your infant is not able to kick their legs actively
  • Areas of skin develop redness or rashes
  • The harness seems to be too small for your child’s body dimensions
  • You have problems adjusting the harness and straps