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Our little miracle baby was born 10 weeks too soon. He gradually gained weight and could come home when he was three months old. Now at 10 months, we are discovering his hips aren't forming like they should. He has a problem called developmental dysplasia of the hips. They put him in a special harness but he developed a nerve palsy. How often does this happen and is it because he was premature?
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Children born with developmental dysplasia of the hip (DDH) are often treated with a special device called the Pavlik harness. This canvas sling holds the child's hips and knees bent with the legs spread apart.
The idea of the Pavlik harness is to get the round head of the femur in close contact with the hip socket. This position helps the hip form a deeper socket that is less likely to dislocate. Many studies have been done now to show that this nonoperative approach to the problem is quite successful.
Physicians have known for a long time that femoral nerve palsy is a potential complication from the use of a Pavlik harness for developmental dysplasia of the hips. The extreme flexed position of the hip can put pressure on the femoral nerve that supplies the muscles along the front of the thigh.
Orthopedic surgeons treating this problem at the Texas Scottish Rite Hospital for Children in Dallas, Texas did a study on this problem. They found that there was a 2.5 per cent incidence of femoral nerve palsy (that's the 30 children out of the total 1218 in their study).
Most of those (87 per cent) developed in the first week after starting use of the harness. The palsy group were older, larger (taller and heavier), and had more severe dysplasia. Being a preemie, your son may not fall into the older, larger category. But if his dysplasia is more severe (requiring a more extreme harness position of hip flexion), that may account for the nerve palsy.
The study helped show why femoral nerve palsy develops with use of the Pavlik harness for developmental dysplasia of the hip. Future studies may be able to show ways to avoid this problem and improve the outcomes with harness use.
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