# Gradual Reduction Using Overhead Traction for Late-Detected Developmental Dysplasia of the Hip: A Report of Three Cases Diagnosed Among Children Over Four Years Old

## TL;DR

This paper reports on three cases of late-detected hip dysplasia in children over four years old successfully treated with gradual reduction using overhead traction.

## Contribution

The study demonstrates the feasibility of gradual reduction using overhead traction in children older than four years, previously unexplored.

## Key findings

- Stable hip reduction was achieved in all three patients without redislocation.
- Avascular necrosis occurred in children aged five or older, suggesting protocol modifications.
- The duration of horizontal traction was longer than usual in these cases.

## Abstract

Optimal reduction methods for late-detected developmental dysplasia of the hip (DDH) remain debatable. Gradual reduction (GR) using traction is a safer and more reliable option for late-detected DDH than closed reduction or open reduction with or without preliminary traction. GR using overhead traction, one of the current GR methods, has been indicated for children of walking age up to four years of age, whereas the upper age limit of this method has not yet been determined. We present three cases of late-detected DDH whose hips were treated between four and six years of age with this method. Stable reduction without subsequent redislocation was technically accomplished for all patients, albeit the duration of horizontal traction became longer than usual. Clinically significant avascular necrosis (AVN) has developed in children aged ≥5 years, indicating the need for some modifications to the conventional protocol to prevent AVN.