You Do Not Need to Pull Out the Onion to See if It Is Growing

Background: The purpose of this study is to evaluate outcomes and complications in developmental dysplasia of the hip (DDH) patients that undergo closed reduction and 3 consecutive months of hip spica casting without a planned 6-week midpoint cast change. Methods: A retrospective review was performed of patients diagnosed with DDH treated with closed reduction and spica casting at a single tertiary care pediatric hospital. Clinical documentation was reviewed to identify complications, which were divided into 2 time frames: during the planned casting period and after completion of the planned casting period. Results: Forty-four patients were included. The series consisted of 39 (89%) females and 5 (11%) males with a median age of 9 months and median length of follow-up of 3.2 years. Nine (21%) patients experienced a complication during the casting period. Seven (16%) of these patients experienced a cast-related complication and one patient experienced 2 separate cast complications. These complications included 3 (7%) instances of soiled casts and 5 (11%) patients who outgrew their casts. The median time to cast complication was 36 days. None of the patients with a cast complication experienced further complication after completion of their planned casting period. The remaining 2 patients who experienced a complication during the casting period lost reduction and returned to the OR for open reduction. Nine (21%) patients experienced a total of 14 postcasting period complications. Seven (16%) patients had redislocation of the hip, 5 (11%) patients developed proximal femoral growth disturbance (PFGD), and 2 (5%) patients developed a leg length discrepancy (LLD). There were 20 patients with unplanned return to the OR throughout the study period: 8 in the casting-complication cohort, 7 in the postcasting complication cohort, and 5 patients who did not experience a complication and returned to the OR for separate indications. Conclusions: Closed reduction for DDH with 3 consecutive months of spica casting without a planned cast exchange can yield good outcomes in most patients with acceptable rates of cast-related complication, redislocation, and unplanned return to the OR for cast exchange. Level of Evidence: Level V.