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Abstract

The indications for using abduction splints in developmental dysplasia of the hip (DDH) are not clearly defined. In this study, the authors prospectively evaluated 797 babies born between 1996 and 1998 as part of a limited targeted ultrasound screening program. In the first group (1996-97), babies with clinical hip instability at first scan were placed in a Pavlik harness. In the second group (1998), only babies who had persistent instability at 2 weeks were splinted. Children with persistent major dysplasia at 9 weeks were splinted in both groups. The splintage rate was 1.6/1,000 live births in the first group and 0.8/1,000 live births in the second group. The rate of surgery for DDH did not increase despite a significant decrease in the number of babies being splinted. This study demonstrates that a splintage rate as low as 1.3/1,000 live births (average rate for 1996-98) can be achieved without adversely affecting the outcomes following treatment of DDH.

The natural history of abnormal ultrasound findings in hips of infants under six months of age

“…For the groups Graf IIa to D (4023 individual hip follow-up periods), the outcomes of normalization without treatment were, respectively, 80%, 97% and 96% at ages six weeks, three months and six months. 31 – 33 Two smaller reports with follow-up times between two weeks and 15 months and six weeks and six months had similar results of 92% and 94%, 30 , 34 In one report Graf IIa to IV was not reported separately in 301 abnormal hips in week one and 93% of the hips had normalized at age one month. All these hips were still normal at follow-up at age one year.…”

“…Sampath et al 30 defined major dysplasia as an alpha angle below 43° or subluxation. The number of hips with developmental dysplasia of the hip (DDH) in the children was not described.…”

Screening for developmental dysplasia of the hip: current practices in Ireland

“…Observational studies demonstrate high spontaneous resolution rates in infants with hip dysplasia [3,4]. Dezateux et al [6] reported that the proportion of children with favourable treatment outcomes (based on UK data) was higher for selective ultrasound screening than for clinical screening or no screening; 88 versus 78 and 75%, respectively, and resulted in the highest proportion achieved without recourse to surgery; 79 versus 18% for clinical assessment.…”

“…Conversely, the majority of infants with risk factors do not develop hip dysplasia [2]. Early detection is considered important to optimise treatment outcomes however; numerous observational studies report high spontaneous resolution rates without recourse to treatment [3,4]. Published data concerning national screening practices for hip dysplasia is limited [5].…”