Abduction Brace Use After Hip Spica Cast in Developmental Hip Dysplasia

Developmental hip dysplasia (DDH) is a condition that can be treated successfully when diagnosed early and managed appropriately. In cases of completely dislocated hips, closed reduction followed by a hip spica cast is a widely accepted treatment method.

However, treatment does not end when the cast is removed. The post-cast period is a critical phase during which the hip remains vulnerable to redislocation while acetabular development continues. For this reason, abduction brace use is an essential part of ongoing treatment.

Why Is an Abduction Brace Needed After Cast Removal?

Even after successful reduction with a hip spica cast:

• The hip joint remains at risk of redislocation
• The acetabulum has not yet fully developed
• Capsular and ligamentous stability is still incomplete

An abduction brace maintains the hip in a safe position of flexion and abduction, helping preserve reduction while allowing normal joint development. Therefore, brace use should be considered a continuation of active treatment, not merely a protective measure.

Which Abduction Brace Is Preferred After Casting?

In the post-cast period, rigid or semi-rigid abduction braces that provide adequate hip stability are preferred. One of the commonly used systems is the Cruiser-type abduction brace.

This brace maintains controlled hip positioning, adapts well to infant movement, and is suitable for prolonged use.

Recommended Abduction Brace Protocol

Phase 1 – Critical Stabilization Period

• Duration: First 6 weeks
• Use: Approximately 23 hours per day
• Removed only for bathing and brief hygiene care

Wearing the brace only during sleep is not sufficient during this phase. Continuous use is required to ensure stable hip positioning.

Phase 2 – Transition Period

• Duration: Following 6 weeks
• Use: 12–14 hours per day
• Typically during nighttime sleep and daytime naps

Brace Positioning

• Hip flexion: approximately 90–100°
• Hip abduction: approximately 40–45°

Excessive abduction should be avoided, as improper positioning may compromise femoral head blood supply.

Follow-Up and Monitoring

Regular clinical and radiological follow-up is essential. An anteroposterior pelvic radiograph is usually obtained at 6 weeks to confirm concentric hip reduction.

Acetabular development is typically monitored until 18–24 months of age.

Conclusion

Successful DDH treatment relies on appropriate casting and consistent abduction brace use. The brace is not the final step of treatment, but rather a critical phase that ensures long-term stability and healthy hip development.

Related Topics

• What Is Developmental Hip Dysplasia (DDH)?
• Hip Spica Cast Treatment in Developmental Hip Dysplasia