Dislocatable Hip and Dislocated Hip in the Newborn Infant

Abstract

In the five-year period 1962–6 a total of 14,594 infants were born alive in a single maternity department. Except in the few instances when death occurred very soon after birth, the hips of all were examined within 36 hours of birth. The condition of the hip joint was specifically noted on a survey sheet in each case. All the examinations were carried out as a routine by a member of the paediatric team. Excluding two cases of dislocation of the teratological type and all cases of meningomyelocele, 60 infants with clearly dislocatable or dislocated hips were discovered. The female preponderance was nearly 4 to 1. Approximately one-third were bilaterally affected, and in the remainder the left hip was 5.5 times more often involved than the right. In 22% of the cases there had been a breech delivery. During the last two years of the study the incidence of neonates with dislocatable or dislocated hips of unstable type was 5 per 1,000, and in half of these infants the hip was dislocated. A clinical classification of the state of the hip joint in the newborn infant is suggested, with reasonably clear-cut groups as a mean of comparing accurately the findings in different centres. The technique of clinical examination of the hip joints within 36 hours of birth is given in detail, and should be a routine procedure, as it can lead to the prevention of established dislocation, at least in the great majority. At present this involves the splinting of approximately four cases which would spontaneously stabilize for every one case which would finally remain dislocated. The implications of this are discussed. Splinting of the hips in abduction should be carefully confined to infants who are at real risk, and in these the splint should be applied within four days of birth if possible. In our series a von Rosen type splint proved satisfactory, and it was kept on the infant for an average Period of three months. Details are given of the follow-up investigation carried out on the children with abnormal hips. Two infants died in the neonatal period and two were not available for follow-up. Owing to inadequate or late splinting in the earlier cases of the series, four cases of dislocation were not prevented, and these required further attention. © 1967, British Medical Journal Publishing Group. All rights reserved.