Screening of Children with Congenital Dislocation of the Hip Joint on the Maternity Wards in Sweden

ABSTRACT. Objective. To evaluate an organizational model for neonatal population screening for developmental dysplasia of the hip.Methods. In 4648 neonates born in six hospitals of the Lombardy region, screening for developmental dysplasia of the hip was done using the Ortolani-Barlow maneuver and ultrasonography.Results. The frequency of positive results of clinical and ultrasound examinations carried out in the hospitals varied considerably as a result of difficulties in the Ortolani-Barlow test reproducibility and in the low sensitivity of the clinical examination when compared to ultrasonography. Neonatal screening results implied a large number of subjects with a IIa hip, according to Graf's system; as these subjects require follow-up, the cost of this type of screening is high. Ultrasound findings were normal at 69 days of life in 88% and 75% of subjects, respectively, with unilateral and bilateral type IIa hip.Conclusion. This study evaluated various organizational models for screening (for different time periods and for selected populations) in relation to the costbenefit ratio and demonstrated the different problems that still impede identification of a correct screening model. Pediatrics 1997;99(2). URL: http://www.pediatrics. org/cgi/content/full/99/2/e5; congenital dislocation of the hip, developmental dysplasia of the hip, clinical screening, newborn, reliability, ultrasonography.

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“…An appropriate therapeutic intervention during this period [1][2][3][4][5][6][7] can change the natural history of the disorder positively.…”

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confidence: 99%

Screening for Developmental Dysplasia of the Hip: From Theory to Practice

et al. 1997

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“…20 It is likely that many factors, including the age of application and degree of abduction, affect the rate of avascular necrosis. 16,21 For instance, in the comparative series reported by Bradley et al 20 babies under the age of six weeks were treated primarily with the von Rosen splint and older babies with the Pavlik harness; the different rates of avascular necrosis in these groups may be explained by age as well as the type of splint. Pressure deformity of the femoral head caused by the von Rosen splint has been reported, although this decreases with age and is avoided when adequate mobility within the splint is allowed.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have shown the von Rosen splint to be effective, [14][15][16] but the use of the Pavlik harness has become more widespread in recent years. There is no previous published comparison of the von Rosen splint and the Pavlik harness.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of the Pavlik harness, the Craig splint and the von Rosen splint in the management of neonatal dysplasia of the hip

Wilkinson

Sherlock

Murray

2002

The Journal of Bone and Joint Surgery. British volume

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After many years of research into the detection and management of neonatal hip dysplasia there is a growing consensus that ultrasound is useful in the selection of hips which require splintage. It can detect some dysplastic hips which are missed on clinical examination 1-3 and exclude significant dysplasia in some hips which are thought to be abnormal clinically. 4 There is, however, relatively little information in the published literature on the use of ultrasound to assess the outcome and compare splinted hips with those without splintage and the effectiveness of different splints. As a result a variety of protocols for splintage is in use. In our hospital babies presenting with clinical instability of the hip may be treated by observation and no splintage or splinted using either a Pavlik harness, a Craig splint or a von Rosen splint. The management is determined by the orthopaedic consultant in charge of the patient, and this depends on which day of the week that the request for an opinion is received. Ultrasound assessment of babies with clinically suspected instability of the hip began in our hospital in 1993 and thereafter most hips were morphologically classified using the classification of Graf 5 before being seen in the orthopaedic clinic. Their progress is monitored by ultrasound. The radiologist (AGW) noted that dysplasia in babies treated with the von Rosen splint appeared to resolve more quickly than that which had other protocols of treatment. We have therefore reviewed the imaging and clinical outcome of all babies presenting with Graf type-III and type-IV dysplasia in order to assess the effectiveness of the different protocols of management. Patients and MethodsThe ultrasound reports of all babies who were imaged for clinically suspected neonatal dysplasia of the hip between 1993 and 1998 were reviewed and those classified as Graf type III or type IV formed the basis of the study. Babies had been referred because of clinically suspected instability or the presence of risk factors for hip dysplasia. The scans were reassessed and those in which the quality of the image was inadequate (incorrect plane of imaging), or were not unequivocally Graf type III or type IV, were excluded from the study. Babies who were first imaged over the age of three months and those with a neurological abnormality were also excluded. A total of 134 hips in 96 babies (84 girls and 12 boys) was included in the study.The imaging was reviewed with particular attention to the first ultrasound examination, that carried out at 12 to 20

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“…This has been achieved in the developed world, through improved awareness and training, increased surveillance (use of ultrasound), and quicker access to paediatric orthopaedic surgeons. 31 must be noted that there are very few specialized paediatric orthopaedic surgeons in the developing world, and [32] .…”

Section: Screening Programme For Ddhmentioning

confidence: 99%

Developmental dysplasia of hip – An overview

Rk¹,

Patel²

2017

Int. J. Orthop. Sci.

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Developmental dysplasia of the hip refers to a spectrum of severity ranging from mild acetabular dysplasia with a stable hip, to more severe forms of dysplasia with hip instability, to established hip dysplasia with or without subluxation or dislocation. DDH affects 1-3% of newborns and is responsible for 29% of primary hip replacements in people up to the age of 60 years. Ligamentous laxity is also believed to be associated with hip dysplasia, though this association is less clear. The treatment of DDH is age-related and the goal is to achieve and maintain concentric reduction of the femoral head into the acetabulum. A dislocated hip which can be reduced and a reduced hip that can be subluxated should be treated with the orthosis. All such hips should be treated in orthosis or harness beginning at the time of diagnosis. This results from excessive pressure on the femoral head after reduction in extreme abduction and internal rotation leading to vascular occlusion. Avascular necrosis results from excessive pressure on the femoral head after reduction in extreme abduction and internal rotation leading to vascular occlusion. Developmental dysplasia of the hip is a challenging condition. Formal training in the treatment of various age groups with DDH is mandatory. Successful treatment with Orthoses requires careful counselling of parents. Surgical management requires careful pre-operative planning and adequate follow up to ensure the best clinical outcomes.

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Screening of Children with Congenital Dislocation of the Hip Joint on the Maternity Wards in Sweden

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Screening for Developmental Dysplasia of the Hip: From Theory to Practice

Screening for Developmental Dysplasia of the Hip: From Theory to Practice

The efficacy of the Pavlik harness, the Craig splint and the von Rosen splint in the management of neonatal dysplasia of the hip

Developmental dysplasia of hip – An overview

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