A Pavlik harness is an orthotic used to gently position the baby’s hip in an acceptable position. Pavlik harness is often recommended for children with hip joint and femur problems from birth till 6 months of age.
when to use a pavlik harness
There are some conditions that often call for use of this hip abduction brace. These are:
- Developmental Hip dysplasia(DDH)
Developmental hip dysplasia means that the ball of the upper part of the thigh bone (femur) is not completely covered by the socket and therefore at high risk of dislocating. Therefore the harness is employed to keep the joint in an acceptable position to prevent that.
- Fracture of the femur
If a child under 6 months sustains a fracture of the femur (thigh bone) a Pavlik harness is worn to maintain the leg in an acceptable position as the bone heals.
Do you need to see paediatric orthopaedic surgeon?
How long will my child need a Pavlik harness?
Doctors recommend full-time wear of the brace, where the brace is not removed and is kept on during bathing, diaper changes, and even at night. The brace can be removed at night for skin checks and to let the baby stretch their legs then the brace is put back on.
The baby will sleep on the back, not the tummy.
After a while, if the treatment is successful, your doctor will adjust the time. This bracing will last from about 6 to 12 weeks.
Even though only one side is affected, this non-rigid abduction orthosis needs to be worn on both sides to work effectively.
How to apply and position a pavlik harness
Technically, this abduction brace is made of 4 major parts which are: the shoulder strap, chest band, connecting strap, and foot cuff which also has a stirrup.
Step 1
Apply the chest halter just around the nipple level. One large strap will go around the chest while the rest will go over the shoulders and anchor onto the front chest halter.
Step 2
Apply the stirrup. This comprises 2 pieces that support the feet. A piece will go around the foot and must be securely fastened around the foot and the upper part of the calf.
Step 3
Apply the flexor strap. This strap combines the straps on the foot to the one on the chest. There are 2 main straps, one on the front and another on the back. The front one is anchored onto the anterior part of the chest halter. This strap keeps the hip in a flexed position of approximately 90 degrees.
Step 4
Applying the abduction strap. The posterior strap from the foot is anchored onto the back part of the chest halter. This maintains abduction of the hip joint.
How to adjust a pavlik harness
Normally the doctor or orthotist will put the pavlik harness in the best position possible and it should stay this way. During routine visits and as the child grows, the doctor will adjust the hip abduction brace accordingly and also teach you what needs to be done.
Signs that a pavlik harness is working
This can be done in various ways.
First of all, it is best assessed by your child’s doctor using an ultrasound scan to measure some angles around the hip joint and determine the centralization of the head of the femur in the acetabulum (hip socket)
Manual maneuvers can also be tried like the Barlow and Ortolani technique to assess the stability of the joint. This should only and only be tried by the doctor!!
How long to use a Pavlik harness
- For DDH, the harness will be worn for 6 to 12 weeks until the ultrasound scan is done and shows an intact joint. Your child will have serial ultrasound examinations to check for the position of the hip joint.
- In Fractures of the femur, the harness will be used for about 4weeks or until signs of bone healing are evident on the x-ray.
Complications of Pavlik harness use
- Femoral nerve palsy
This is the most common complication of this hip abduction brace use. It occurs if the flexion of the hip joint is extreme, leading to compression of the nerve at the bikini area.
This can be noticed when your baby does not kick with that leg as much compared to before.
What to do?
Release the traps on that affected side and see your doctor as soon as possible for further assessment.
- Inferior hip dislocation.
This means that the hip dislocates downwards. This is also prompted by excessive flexion at the hip joint. Dislocations are painful and require urgent reduction to prevent further compromise to the cartilage on the joint surfaces.
The child may cry uncontrollably and there will be painful movement at the affected hip joint.
What to do?
In that case, you need to see your doctor urgently and get advice on the way forward.
- Avascular necrosis of the femoral head
Avascular necrosis is a fancy term meaning the death of a particular body part due to diminished blood supply. This issue commonly occurs in the upper part of the femur following injury, dislocation or infections early in life.
This can also happen if there is forceful abduction at the hip joint.
Does a pavlik harness delay development?
A Pavlik harness does not delay development. If anything, it will help the proper positioning of the hip in the socket allowing proper growth and preventing the complications associated with a poorly positioned hip joint.
Pavlik harness care
It is important to keep the Pavlik harness clean since it is going to be on the baby’s body.
In case it is soiled, even though you are not allowed to take it off the child, just spot-clean it while it is on the baby and leave it to air dry.
Don’t wash it in the washing machine as this can spoil it.
In conclusion, the Pavlik harness is a brace commonly used in babies for the treatment of dislocated hips and for femur fractures. The doctor will guide you on the use of this brace and how the complications are managed.
