The Czech orthopedic school achieved renown around the world with the principle of abduction positioning to prevent and treat congenital hip joint defects in children during their first year of life. In the first half of the 20th century, important figures of Czech orthopedic history (professors Pavlik, Frejka, Hanausek and Zahradníček) uncovered how important the position of the lower extremities is for the healthy development of hip joints and designed preventive wrapping for children in abduction (= straddling the legs), which was a unique method that was gradually adopted in other countries. Many generations of children have benefited greatly from this work with healthy hip joint development. Oddly enough however, even today this is not the standard in many countries and the incidence of congenital hip dysplasia in those countries demonstrates that these greats of the Czech pediatric orthopedics were right. In addition, terms such as the Frejka pillow or Pavlik harness have become well-known within the global orthopedics community and are still used today around the world.
As pediatric orthopedics progresses in concert with other disciplines, the question of whether permanent abduction positioning and wrapping is still needed is currently a topic of discussion within the pediatric orthopedics community. It is also necessary to note that the Czech Republic was one of the first countries in the world to introduce ultrasound examinations of hip joints in children as routine screening, which quite effectively helps detect congenital developmental hip joint shape deviations early, even in newborns, and enables the precise and targeted treatment of pathological conditions. This screening is conducted in 3 phases: in the event of pathological findings, it is performed at the maternity hospital, but in most cases at 6 weeks, 4 months and a third screening conducted as needed depending on the condition. There is a consensus that the traditional wrapping method using folded diapers is obsolete. Therefore, attempts are being made to find another easily applicable aid to maintain the desired hip joint position. For newborns and infants with normal development disposable diapers do the job. However, in the event of a deviation in the shape of the hip joint cavity (acetabulum), a more effective method of affixing the hip into abduction is needed. Several aids are readily available: the already mentioned Frejka pillow, Pavlik harness and most recently a new product from Marwell Medic, a corrective orthopedic abduction bandage which is classified as a standard aid on the VZP Price List. In my out-patient practice, which annually screens the hop joint development of approx. 1,400 children in their first year of life, I have had the opportunity to become familiar with and test the effectiveness of this product. We used this aid on hip joints with II B, II C, II D ultrasound findings according to Graf. We did not use it to treat patients with III A and III B findings which are indicated for distraction treatment under hospitalization. In all cases, the use of this corrective abduction bandage resulted in improved findings and their shift in the ultrasound classification by 1 or 2 levels and a resulting classification in category I. The distraction method had to be used only in 3 out of 65 children with class IIC and their hip joint development continued to be highly pathological.
It should be noted that some orthopedic aids for the treatment of hip joint dysplasia in newborns are too thick from front to back with Velcro fasteners that are for the most part sewn on in the wrong direction. A high layer on the back positions newborns and infants almost permanently with an extremely arched back. This position reduces their initial locomotive development, mainly the physiological dorsal and neck reflexes. The new MARWELL corrective abduction bandage eliminates these deficiencies and enables the correct physiological position in newborns and infants while maintaining the full therapeutic effect.
In conclusion, it can be said that there is a new high-quality aid with proven effectiveness and this made possible its inclusion in the VZP Aid Price List. It meets all the requirements for such aids at the beginning of the new millennium both in terms of design and materials. It consequently also meets all expert, hygienic and technical requirements. This aid does not have to be used exclusively for the treatment of serious pathologies, but can also be used in borderline cases as an easily applicable and well-tolerated preventive aid, which has a longer useful life than either the Pavlik harness or the Frejka pillow and thus may even be kept for the next child in the family.
In view of all these aspects, the MARWELL corrective orthopedic abduction bandage can be recommended for both the treatment and prevention of congenital hip joint dysplasia in children.
Dr. Jan Charvát, MD, PhD
