The MARWELL corrective abduction orthopaedic bandage - an effective aid?

The Czech school of orthopaedics became famous worldwide for the principle of abduction positioning in the prevention and treatment of congenital disorders of the hip joint in children in the first year of life. Major personalities of our orthopaedics profession – professors Pavlik, Frejka, Hanausek and Zahradníček – understood in the first half of the last century how important the position of the legs was for correct development of the hip joints and suggested preventive swaddling of children in abduction = straddled legs. In the worldwide context this was a unique method, which was gradually adopted by other countries and which provided many generations of children with a great benefit in the form of correct development of the hip joints. Surprisingly it is not common in many countries yet. The incidence of congenital hip joint dysplasia in these countries however proves our celebrities of paediatric orthopaedics right. Furthermore the terms such as Frejka pillow or Pavlik braces have become known in international orthopaedics and they have been used in every country under these terms.

The development of paediatric orthopaedics is of course progressing together with other medical disciplines and there is a discussion in our orthopaedic community as to whether permanent abduction positioning and swaddling is still necessary. It should also be noted that our country is one of the first in the world to have introduced ultrasound examination of hip joints in children as routine screening, which often effectively helps to reveal congenital developmental deviations of the shape of the hip joint from the newborn period and enables an exact and targeted therapy of pathological conditions. It takes place in 3 phases – in case of pathological findings, it is performed in the maternity clinic; otherwise in the 6th week and 4th month and the third screening in accordance with the condition and necessity. There is a consensus that traditional swaddling in the form of folded nappies is obsolete. There are therefore efforts to find an easily applicable aid which is used to maintain the required position of the hip joints. This role is achieved in newborns and infants by the disposable nappies from various companies sufficiently in the case of normal development. When there is a deviation mostly in the shape of the head of the hip joint = acetabulum, it is necessary to choose a more efficient way of fixation of the hips in abduction, and we have several aids available – the already mentioned Frejka pillow, Pavlik braces and now a new product from the Marwell Medic company – a corrective orthopaedic abduction bandage, which is included in the tariff of the General Insurance Company (VZP) as a standard. In my outpatient clinic, in which I examine yearly 1400 children in their first year of life in the framework of screening of the development of hip joints, I had an opportunity to get familiar with this product and to examine its efficiency. We have used this aid for hip joints with an ultrasound finding of II B, II C, II D according to Graf; we haven’t tried it in the treatment for findings III A and III B indicated for distraction treatment under hospitalisation. In all cases an improvement of the finding and a shift of the ultrasound classification by 1 - 2 degrees higher occurred after using this corrective abduction bandage and a final placement to category I. Only in 3 children from 65 within group IIC, did distraction therapy have to be used and the development of their hip joints continued to be significantly pathological.

On this occasion it should be noted that some orthopaedic aids in the treatment of hip joint dysplasia in newborns are too thick in the anteroposterior dimension and the fasteners are stitched in an inappropriate direction. A high layer of reinforcement material on the back positions the newborn and infant virtually in permanent opisthotonus. This position reduces their primary locomotor development, mainly the physiological dorsal and nuchal reflexes. These imperfections are removed by the new MARWELL corrective abduction bandage and enable a physiological position in newborns and infants while maintaining a complete therapeutic effect.

Finally it can be noted that this is a new quality aid with proven efficiency, which was entered on the tariff of aids of the General Insurance Company. Its form fulfils the requirements on such aids at the beginning of the third millennium in terms of its design as well as the materials from which it is made, and it therefore fulfils the requirements from the expertise, hygienic as well as tolerance point of view. It need not be used only for therapy of greater pathology but in borderline findings as an easily applicable and well tolerated preventive aid, the lifetime of which surpasses the Pavlik braces as well as the Frejka pillow and it may be kept for the next child in the family.

This MARWELL corrective orthopaedic abduction bandage can be recommended from all of these points of view for therapy and prevention of congenital hip joint dysplasia in children.

MUDr. Jan Charvát CSc.
Specialist in paediatric orthopaedics, member of EPOS, AACPDM