Journal of Pediatric Orthopaedics - 2026-07-01 - Journal Article; Comparative Study
Hip Abduction Brace Is an Effective Treatment Alternative for Femur Fractures in Infants 12 Months and Younger.
Murphy-Zane MS, Keeter C, Baumann A
Topics
Key Takeaway
Hip abduction brace achieves equivalent residual fracture angulation to Pavlik harness and spica cast for infant femur fractures, with 0% complication rate versus 10.3% femoral nerve palsy in Pavlik-treated infants ≤6 months.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This retrospective cohort study compared hip abduction brace (HAB), Pavlik harness, and spica cast for proximal or diaphyseal femur fractures in infants ≤12 months, stratified by age ≤6.99 months and 7–12.99 months. Among 148 fractures (74 Pavlik, 48 spica, 22 HAB), no statistically significant differences in residual lateral or coronal angulation were found between groups at final follow-up. Femoral nerve palsy occurred in 10.3% of Pavlik-treated infants ≤6 months; zero complications were recorded in the HAB and spica groups.
Key Limitation
The HAB group was less than one-third the size of the Pavlik group, making the study underpowered to confirm true equivalence rather than simply failing to detect a difference.
Original Abstract
BACKGROUND
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.
METHODS
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 χ 2 tests (α=0.05).
RESULTS
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.
CONCLUSIONS
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 OF EVIDENCE
Level III-therapeutic study: retrospective comparative study.