Late diagnosis dislocation of the hip joint in children

Abstract

Dating from 1953, the hips of newborn have been examined routinely all over Sweden. In 1963 more than 99 per cent of all newborns (about 110,000) were delivered at maternity departments, where such examination was recommended. 615 cases of preluxation or dislocation were diagnosed, which means a frequency of 5.6 per thousand. A high frequency reported in some hospitals suggests overdiagnosis. To assess to what extent the examination of newborns has reduced the frequency of late diagnosis dislocation and dysplasia, extracts of the records were obtained concerning all infants born in 1963 and treated for dislocation of the hip in 1963-1966 at orthopaedic departments in Sweden. Twenty-seven reported cases were analysed and the children were reviewed after 4-10 years. Fourteen (52 per cent) of the children were found to have normal or practically normal hips at the review. Eight still had dysplasia with subluxation and 3 had substantially deformed joints, one had moderate deformity and one, untreated, still had luxation. Possible causes of late diagnosis are discussed and it is stressed -- that all physicians who examine newborns should be well versed in examination of the hip joints.--that the hip joints should, when possible, be examined on two occasions during the first weeks of life, especially newborns predisposed to dislocation owing to heredity, breech presentation or different kinds of malformations.--that it should be borne in mind that complete luxation, though rare, may exist already in the neonatal period,--that one should not forget to examine the hips of newborns who, because of prematurity, asphyxia etc., are referred immediately for intense treatment before routine examination of the hips has been carried out,--that a child health centes one should not rely on the results of the examination during the neonatal period, but should always examine the hip joints.