Early Outcomes of Closed Reduction Followed by Double Spica Casting and Gait Assessment in Children Aged 18–48 Months with Developmental Dysplasia of the Hip

Developmental Dysplasia of the Hip (DDH) in children aged 18–48 months is associated with more limited acetabular remodeling potential compared with infancy. Although open reduction is frequently considered in this age group, closed reduction followed by spica casting remains an option in selected patients. Evidence linking early radiographic correction to short-term functional recovery remains limited. To describe early radiological and clinical outcomes and short-term gait characteristics in DDH patients aged 18–48 months treated with closed reduction followed by a double spica casting We conducted a retrospective case series of nine patients (10 hips) undergoing closed reduction followed by double spica casting for unilateral or bilateral DDH between 2023 and 2025. Radiological evaluation included Acetabular Index (AI), center–edge angle values, and Residual Acetabular Dysplasia (RAD) values , Radiographic outcomes at final follow-up were graded using the Severin classification. Avascular necrosis (AVN) was assessed using the Bucholz–Ogden classification. Clinical function was evaluated using the McKay criteria. Side-to-side gait comparisons were performed in unilateral cases only (n=8); the bilateral case was reported descriptively. Minimum follow-up was 12 months. AI decreased from 39.44° pre-intervention to 26.82° at final follow-up, and center–edge angle at follow-up averaged 16.62°. No redislocation was observed during the available follow-up period. No radiographic evidence of AVN or residual acetabular dysplasia was detected within the follow-up window. Spatiotemporal gait parameters showed limited inter-limb differences at short-term follow-up; structured observational gait assessment identified gait deviations in a subset of unilateral patients. In this small case series, closed reduction followed by double spica casting achieved early radiographic improvement. No AVN was detected within approximately one year of follow-up; however, the small cohort size and limited follow-up preclude definitive conclusions regarding long-term safety and functional recovery.