Hip Abduction Brace Is an Effective Treatment Alternative for Femur Fractures in Infants 12 Months and Younger.

Abstract

Femur fractures in infants ≤12 months are rare but significant injuries. Traditional methods of immobilization such as the Pavlik harness and spica cast have limitations related to fracture stability, comfort, and caregiver burden. The hip abduction brace (HAB), widely used for developmental dysplasia of the hip (DDH) treatment, has not been well-studied for infant femur fracture management. This study evaluated the efficacy of the HAB compared with the Pavlik harness and spica cast in infants ≤12 months with femur fractures. Following IRB approval, we conducted a retrospective cohort study of infants ≤12 months with proximal or diaphyseal femur fractures at our level one pediatric hospital trauma center from 2013 to 2024. Patients were categorized by treatment method (Pavlik harness, HAB, or spica cast) and analyzed in 2 groups at age of injury: ≤6.99 months (group A) or 7 to 12.99 months (group B). Demographic, clinical, and radiographic data was collected. The primary outcome was residual fracture angulation at final follow-up. Comparisons between treatment groups used linear mixed models, ANOVA, and χ2 tests (α=0.05). A total of 143 patients (148 fractures) were included. Overall mean age was 5.15 months at the time of injury (2.82±2.00 mo in group A, 9.36±1.65 mo in group B). Seventy-four fractures were treated with the Pavlik harness, 48 with Spica cast, and 22 with the HAB. Four fractures treated with a splint were excluded from this analysis. Initial imaging showed no statistical differences in initial angulation, fracture pattern, or fracture location between the treatment groups. While numerical data showed lower residual lateral angulation in the HAB group following treatment, there were overall no significant differences between treatment groups in both group A and group B. Femoral nerve palsy occurred in 10.3% of Pavlik-treated infants ≤6 months, but no complications were noted in the HAB or spica cast groups. In this large cohort study of infants ≤12 months with proximal or diaphyseal femur fractures, treatment with a hip abduction brace (HAB) resulted in radiographic outcomes that were equivalent to the Pavlik harness and spica cast, without any major complications. The HAB is an effective and practical treatment for infant femur fracture. Level III-therapeutic study: retrospective comparative study.