Conservative treatment really means treating the condition without an operation. The aim of this treatment is to hold the thighs spread apart. (You may hear a doctor say "abducted"). This manoeuvres the ball at the top of the thigh into the hip socket and keeps it in place. This position helps the socket to mould around the ball shaped head of the femur and grow properly. The aim is to stabilise the hip. Conservative treatment usually refers to splints, traction or sometimes plaster casts applied without surgery.

Treatment with splints

In the past such treatment used to involve "double nappies" folded in a special way to keep the legs wide apart. The most common splint consists of straps and buckles to hold the legs in the correct position. Other splints are usually made from padded malleable aluminium, shaped either like an 'X' or an 'H'. The splint is moulded over the shoulders and under the thighs. Here are some pictures and descriptions of some of the more commonly used splints.

Before you read on, it is worth pointing out that these splints may look uncomfortable, but for babies everything is new and they adapt to them surprisingly quickly.

Craig or Aberdeen Splint

This splint is often chosen if the baby's hips are unstable but not dislocated. It is a flexible (usually plastic) splint designed to be used over the nappy. The splint is removed at nappy changes.

The Craig or Aberdeen splint is easy to put on but it needs to be fastened securely so it doesn't slip down.

The Pavlik Harness

The Pavlik Harness is lightweight. It allows more movement in the hips but it should still stop the baby straightening its legs out or down. The straps need careful adjustment and your doctor will do this. The Pavlik Harness should never be removed unless it is advised by your doctor.

Von Rosen Splint

The Von Rosen splint is used less often but may be chosen when the hip is already dislocated. It is put on by a doctor and should only be taken off by a doctor.

It is a padded metal frame and is more bulky than the Craig/Aberdeen splint. It holds the hips securely and prevents dislocation. The infant is laid on to the frame, the top pieces are hooked over the shoulders, and the bottom pieces are used to keep the legs in a 'sideways' position. It is worn under the clothes next to the skin.

Denis Brown Abduction Splint.

With the Denis Brown Splint, a metal bar fits across the buttocks. Stiff plastic cuffs are slid up the leg and fixed at thigh level by bolts attached to the metal bar. Straps with buckles keep the harness in position. This splint is perhaps more often chosen for an older child.

Splints are generally put on without anaesthetic and are fitted for varying lengths of time depending on each individual child's progress. However, it's usually more likely to be for a number of months than a number of weeks.

An X-ray or ultrasound scan may be taken once the splint is in place to check that the hips are in the right position.

Splints are used after an early diagnosis of DDH or after the child has been on traction or in plaster.

If the condition is diagnosed later or if simple splints have not worked, traction and plaster fixation will be used.

If the condition is diagnosed later and in cases where splints have not worked, traction and plaster fixation will be used.

Traction involves raising the legs upright or apart and using a system of weights and pulleys to keep the hip in the correct position. .It is used to stretch the soft tissues ( muscles and ligaments) around the hip and is usually maintained for 1 to 3 weeks,. It is often followed by a period in plaster, though this is not always so.

Before traction is begun, the child has what are known as 'skin extensions' applied to his legs. These are not as dramatic as they sound - lengths of wide special non-adhesive "Elastoplast" are applied to the leg to make a kind of stirrup under the foot. Cords can be attached from this to the traction frame. The strappings are covered in bandages to hold the main position. Over several weeks, the cords attached to the skin extensions will be adjusted.

TIP: It's worth checking for any allergies or sensitivities to plaster prior to going into traction. Try to avoid applying sticking plaster directly to the skin.

TIP: Learn how your child's traction works and how to check for sores on hands and feet etc. You are likely to be more vigilant on issues of your child's comfort than the often-overstretched nursing staff.

It's a good idea if the child can be admitted to hospital a few days before being put on traction, so they can get used to their new surroundings.

While the child is on traction, X-rays may be taken from time to time to monitor progress. The child is usually kept in hospital for the length of time on traction although in some cases, the child may be treated at home.

Types of traction

Most traction is now of the overhead type. An overhead frame, sometimes called a gallows frame is put over the cot. The child's legs are then attached to the frame by skin extensions. The baby's bottom should just hang free of the bed. Sometimes the position of the legs are gently adjusted so that they are wider apart (abducted).

Older children may be put in extension traction on a tilted bed.

(Pugh's Traction) The child's body weight provides the counter pull to the weights at the end of the bed.

It is unusual for traction to continue for more than three weeks.