Comparison of inpatient and outpatient traction in developmental dislocation of the hip.

We studied 83 hips in 72 children being treated for developmental hip dislocation to assess the influence of home traction upon the incidence and severity of avascular necrosis (AVN). We compared two types of traction prior to closed or open reduction: inpatient Bryant's skin traction (40 hips), and outpatient (home) Bryant's skin traction (43 hips). No routine in-traction radiographs were taken in either group. After traction, a stable closed reduction was achieved in 55 hips (66%). Open reduction was performed on 28 hips (34%). The rate of severe AVN involving growth disturbance and resultant deformity (Bucholz types II, III, and IV) was low in both traction groups (inpatient, three out of 40, outpatient, one out of 43). These results demonstrate that an outpatient traction program without attention to radiographic hip station is as safe as identically instituted inpatient programs, as well as those that emphasize achievement of a traction reduction or a predetermined hip station.