A 6-month-old infant with DDH has been in a Pavlik harness for 4 weeks. Repeat ultrasound shows persistent dislocation with no improvement. What is the next best step?
- A Continue Pavlik harness for another 4 weeks
- B Discontinue harness, perform closed reduction under arthrogram with spica casting ✓
- C MRI followed by open reduction
- D Switch to a von Rosen splint
Correct answer: B. Discontinue harness, perform closed reduction under arthrogram with spica casting
Explanation
If the hip remains dislocated after 3-4 weeks of Pavlik harness treatment, the harness should be discontinued to avoid complications (avascular necrosis, femoral nerve palsy). The next step is closed reduction under arthrogram with hip spica casting. The failure rate of the Pavlik harness is higher in Graf type III/IV hips. Open reduction is reserved for failed closed reduction.
Reference: Tachdjian's Pediatric Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.