The effect of the design of the orthosis on the axial load transmission of two flexion abduction orthoses used in treating congenital hip dysplasia

Paul Schwanitz von Keitz; Dana Kleimeier; Christoph Fabian Lutter; Mirko Rehberg; Wolfram Mittelmeier; Richard Kasch; Katrin Osmanski-Zenk; Susanne Fröhlich

doi:10.1016/j.heliyon.2022.e11942

The effect of the design of the orthosis on the axial load transmission of two flexion abduction orthoses used in treating congenital hip dysplasia

Heliyon. 2022 Dec 1;8(12):e11942. doi: 10.1016/j.heliyon.2022.e11942. eCollection 2022 Dec.

Authors

Paul Schwanitz von Keitz¹, Dana Kleimeier², Christoph Fabian Lutter³, Mirko Rehberg⁴, Wolfram Mittelmeier³, Richard Kasch³, Katrin Osmanski-Zenk³, Susanne Fröhlich³

Affiliations

¹ Rehafachzentrum Bad Füssing, Orthopädische Klinik, Waldstraße 12, 94072, Bad Füssing, Germany.
² Institut für Bioinformatik, Universitätsmedizin Greifswald, Germany.
³ Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Germany.
⁴ Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Klinik und Poliklinik für Kinder und Jugendmedizin, Köln, Germany.

Abstract

Background: With an incidence of 2-4% in all newborns, developmental dysplasia of the hip, DDH, represents the most frequent congenital disorder of the skeletal system in Germany. The therapy options are deduced with the help of a sonography. The conservative therapy approach includes the application of flexion abduction orthoses, which lead to a development of the child's hip through abduction and flexion angle. The overall structure of the orthoses puts a strain on the axial skeleton of the children. The following work is intended to clarify what role the design of the orthoses plays in this respect.

Methods: Inclusion criterion for the study was fully developed newborns without an indication of skeletal malformations with Type I hip joints according to Graf verified by ultrasound. A total of 19 newborns were recruited and included in the period 3/2013-01/2015. Two types of orthoses used in treating developmental dysplasia of the hip (Tübinger splint, Otto Bock; hip flexion abduction orthosis (Superior orthosis) according to Mittelmeier-Graf, AIDAMED e.K (Kreuz et al., 2012; Mittelmeier et al., 1998; Schmitz et al., 1999), constructions differ, were used. Force was measured with the help of three force sensors, which were even able to be integrated into these without changing the design of the orthosis. In this closed system, force transmission was measured for the duration of a fixed period of two minutes.

Findings: The greatest axial force development (overall force) is in the Tübinger splint with an average force of 15.1 N (min. 0.59 N, max. 53.09 N, mean 15.1, SD 2.46). 4.09 N (min. 0.96 N, max. 20.99 N, mean 4.09, SD 0.65) resulted in the Superior orthosis. Significant correlations between body weight and resulting axial traction - on average during the entire measurement period and in movement - can be taken from the statistical analysis regarding the Tübinger splint. Such a correlation cannot be depicted for the Superior orthosis.

Interpretation: The analysis of the load transmission of the examined flexion and abduction orthoses reveals differences between the models. The construct of the orthoses in itself appears to play a significant role. Long-term effects of orthosis therapy on a child's axial skeleton have not been studied to date. Furthermore, it seems reasonable to expand the test series to orthoses, the design of which is configured in a similar matter compared to the examined aids.

Conclusion: This study proves that the orthotic design has an influence on the infant's axial load.

Keywords: Abduction orthoses; Axial force; Biomechanics; Developmental hip dysplasia; MittelmeierGraf orthosis; Tübinger orthosis.