Slide 006 — Pavlik harness

Clean FRCS notes with inline figures

What is Pavlik harness?

•Dynamic, corrective orthosis to maintain flexion and prevent adduction of hip to keep the hip reduced for dynamic remodeling of the hip

•Use up to 6mth old

•90% success in <3month old presentation

•Other abduction brace: von Rosen splint

Indications?

•Ortolani positive

•Barlow positive at 6 weeks

•Fracture femur

Aim of treatment:

•Maintain stable concentric reduction to promote normal growth of femoral head and acetabulum

•Describe the parts: (5)

•Superior suspensory device

•1. Chest strap at nipple line, can place hand in between

•2. Shoulder straps at anterior axillary line

•Inferior LL orthosis

•Stirrup at popliteal fossa (not too distal or else hyperflexion of knee)

•AM strap to maintain flexion 100 deg, along anterior axillary line

•PL strap prevent adduction, knee able to come together but not touch

•Maintain reduction in Safety zone of Ramsey

Advise to parent:

•General

•Tighten till markers

•Assess any kicking of leg (femoral n, if no, need to relax the strap and FU early) and UL movement (brachial plexus)

•Keep two sets, one for washing

Application sequence

•Supine

•Fasten chest strap

•Fasten shoulder strap to maintain chest strap at nipple line

•Feet at stirrup one by one

•Fasten AM strap to flex hip

•Last PL strap

•ADL

•Change napkin in PH

•Sponge bath + dry completely after

•No self adjustment + regular P&O and ortho FU

Timing:

•When the hip is stable clinically and radiologically (~6weeks) + 6 weeks

USG timing:

•1st time → within 2 weeks after starting harness

•2nd time → end of 1st 6 weeks

•Then before stopping PH

Assessment during FU:

•Confirm concentric reduction cliniczally and radiologically

•Adjustment of size and tension of brace (mainly chest strap and PL strap)

•Compliance

Complication (reduction, nerve palsy)

Complication:

•Failure of reduction

•Inferior dislocation (too much flexion)

•Pavlik harness disease (splintage in incongruent reduction > 1mth)

•AVN (too much abduction) ~2.4%

•Femoral nerve palsy (too much flexion)

•Success rate

•85-95% Omeroglu (Turkey) CORR 2016

Risk factors for failure

•Bilateral disease

•Low alpha angle

•Low percentage of femoral head coverage <20%

•Initial irreducibility

Advanced age at the start of the treatment

•Poor parental compliance

#	lvl	marL	indent	logical	original note line
1	0	None	None	0	What is Pavlik harness?
2	0	171450	-171450	1	Dynamic, corrective orthosis to maintain flexion and prevent adduction of hip to keep the hip reduced for dynamic remodeling of the hip
3	0	171450	-171450	1	Use up to 6mth old
4	0	171450	-171450	1	90% success in <3month old presentation
5	0	0	0	0	Other abduction brace: von Rosen splint
6	0	0	0	0	Indications?
7	0	171450	-171450	1	Ortolani positive
8	0	171450	-171450	1	Barlow positive at 6 weeks
9	0	171450	-171450	1	Fracture femur
10	0	0	0	0	Aim of treatment:
11	0	171450	-171450	1	Maintain stable concentric reduction to promote normal growth of femoral head and acetabulum
12	0	0	0	0	Describe the parts: (5)
13	0	0	0	0	Superior suspensory device
14	0	0	0	0	1. Chest strap at nipple line, can place hand in between
15	0	0	0	0	2. Shoulder straps at anterior axillary line
16	0	0	0	0	Inferior LL orthosis
17	0	228600	-228600	1	Stirrup at popliteal fossa (not too distal or else hyperflexion of knee)
18	0	228600	-228600	1	AM strap to maintain flexion 100 deg, along anterior axillary line
19	0	228600	-228600	1	PL strap prevent adduction, knee able to come together but not touch
20	0	0	0	0	Maintain reduction in Safety zone of Ramsey
21	0	0	0	0	Advise to parent:
22	0	0	0	0	General
23	0	171450	-171450	1	Tighten till markers
24	0	171450	-171450	1	Assess any kicking of leg (femoral n, if no, need to relax the strap and FU early) and UL movement (brachial plexus)
25	0	171450	-171450	1	Keep two sets, one for washing
26	0	0	0	0	Application sequence
27	0	228600	-228600	1	Supine
28	0	228600	-228600	1	Fasten chest strap
29	0	228600	-228600	1	Fasten shoulder strap to maintain chest strap at nipple line
30	0	228600	-228600	1	Feet at stirrup one by one
31	0	228600	-228600	1	Fasten AM strap to flex hip
32	0	228600	-228600	1	Last PL strap
33	0	0	0	0	ADL
34	0	228600	-228600	1	Change napkin in PH
35	0	228600	-228600	1	Sponge bath + dry completely after
36	0	228600	-228600	1	No self adjustment + regular P&O and ortho FU
37	0	0	0	0	Timing:
38	0	171450	-171450	1	When the hip is stable clinically and radiologically (~6weeks) + 6 weeks
39	0	171450	-171450	1	USG timing:
40	1	628650	-171450	2	1st time → within 2 weeks after starting harness
41	1	628650	-171450	2	2nd time → end of 1st 6 weeks
42	1	628650	-171450	2	Then before stopping PH
43	0	0	0	0	Assessment during FU:
44	0	171450	-171450	1	Confirm concentric reduction cliniczally and radiologically
45	0	171450	-171450	1	Adjustment of size and tension of brace (mainly chest strap and PL strap)
46	0	171450	-171450	1	Compliance
47	0	171450	-171450	1	Complication (reduction, nerve palsy)
48	0	0	0	0	Complication:
49	0	171450	-171450	1	Failure of reduction
50	1	628650	-171450	2	Inferior dislocation (too much flexion)
51	1	628650	-171450	2	Pavlik harness disease (splintage in incongruent reduction > 1mth)
52	0	171450	-171450	1	AVN (too much abduction) ~2.4%
53	0	171450	-171450	1	Femoral nerve palsy (too much flexion)
54	0	0	0	0	Success rate
55	0	0	0	0	85-95% Omeroglu (Turkey) CORR 2016
56	0	0	0	0	Risk factors for failure
57	0	171450	-171450	1	Bilateral disease
58	0	171450	-171450	1	Low alpha angle
59	0	171450	-171450	1	Low percentage of femoral head coverage <20%
60	0	171450	-171450	1	Initial irreducibility
61	0	171450	-171450	1	Advanced age at the start of the treatment
62	0	171450	-171450	1	Poor parental compliance

#	semantic level	section?	rewritten line
1	0	yes	What is Pavlik harness?
2	1		Dynamic, corrective orthosis to maintain flexion and prevent adduction of hip to keep the hip reduced for dynamic remodeling of the hip
3	1		Use up to 6mth old
4	1		90% success in <3month old presentation
5	1		Other abduction brace: von Rosen splint
6	0	yes	Indications?
7	1		Ortolani positive
8	1		Barlow positive at 6 weeks
9	1		Fracture femur
10	0	yes	Aim of treatment:
11	1		Maintain stable concentric reduction to promote normal growth of femoral head and acetabulum
12	1		Describe the parts: (5)
13	1		Superior suspensory device
14	1		1. Chest strap at nipple line, can place hand in between
15	1		2. Shoulder straps at anterior axillary line
16	1		Inferior LL orthosis
17	1		Stirrup at popliteal fossa (not too distal or else hyperflexion of knee)
18	1		AM strap to maintain flexion 100 deg, along anterior axillary line
19	1		PL strap prevent adduction, knee able to come together but not touch
20	1		Maintain reduction in Safety zone of Ramsey
21	0	yes	Advise to parent:
22	1		General
23	1		Tighten till markers
24	1		Assess any kicking of leg (femoral n, if no, need to relax the strap and FU early) and UL movement (brachial plexus)
25	1		Keep two sets, one for washing
26	0	yes	Application sequence
27	1		Supine
28	1		Fasten chest strap
29	1		Fasten shoulder strap to maintain chest strap at nipple line
30	1		Feet at stirrup one by one
31	1		Fasten AM strap to flex hip
32	1		Last PL strap
33	1		ADL
34	1		Change napkin in PH
35	1		Sponge bath + dry completely after
36	1		No self adjustment + regular P&O and ortho FU
37	0	yes	Timing:
38	1		When the hip is stable clinically and radiologically (~6weeks) + 6 weeks
39	0	yes	USG timing:
40	2		1st time → within 2 weeks after starting harness
41	2		2nd time → end of 1st 6 weeks
42	2		Then before stopping PH
43	0	yes	Assessment during FU:
44	1		Confirm concentric reduction cliniczally and radiologically
45	1		Adjustment of size and tension of brace (mainly chest strap and PL strap)
46	1		Compliance
47	0	yes	Complication (reduction, nerve palsy)
48	0	yes	Complication:
49	1		Failure of reduction
50	2		Inferior dislocation (too much flexion)
51	2		Pavlik harness disease (splintage in incongruent reduction > 1mth)
52	1		AVN (too much abduction) ~2.4%
53	1		Femoral nerve palsy (too much flexion)
54	1		Success rate
55	1		85-95% Omeroglu (Turkey) CORR 2016
56	0	yes	Risk factors for failure
57	1		Bilateral disease
58	1		Low alpha angle
59	1		Low percentage of femoral head coverage <20%
60	1		Initial irreducibility
61	0	yes	Advanced age at the start of the treatment
62	1		Poor parental compliance

006. Pavlik harness

Clean FRCS notes with inline figures

What is Pavlik harness?

Indications?

Aim of treatment:

Advise to parent:

Application sequence

Timing:

USG timing:

Assessment during FU:

Complication (reduction, nerve palsy)

Complication:

Risk factors for failure

Advanced age at the start of the treatment

Direct Q&A

Ortolani positive

Describe the parts: (5)

Confirm concentric reduction cliniczally and radiologically

Failure of reduction

Success rate

Bilateral disease

Raw speaker-note hierarchy audit

Improved semantic hierarchy used for the study notes