In a four-year retrospective study, we assessed the use of ultrasonography in diagnosing hip dysplasia in 86 high-risk babies. Dysplasia was graded on the Harcke classification.

Risk factors included breach presentation, positive family history, foot abnormalities, caesarean section and genu recurvatum. If the ultrasonography at birth showed abnormalities, follow-up ultrasonography was done at three and six weeks. If there were abnormal findings at six weeks, the patient entered the treatment protocol. Whether or not ultrasonography showed abnormalities at six weeks, the acetabular index was measured radiologically at 12 weeks.

There were 17 Harcke-III hips, 30 Harcke-IV hips and four Harcke-V hips. The Harcke-V hips were treated in a Pavlik splint from birth. Three babies underwent closed reduction at 12 weeks, followed by application of a spica cast. At six weeks, 10 of the Harcke-IV hips and 12 of the 17 Harcke-lll hips were normal. The mean acetabular index at 12 weeks was 28°.

Ultrasonography provides an effective way of screening for hips at risk and the efficacy of treatment can easily be measured.

Reviewing 40 consecutive cases over a two-year period, we tested the efficacy of variable screw plate fixation postoperatively.

A Codman plate was used in all cases. We compared radiological preoperative measurements of the kyphotic angle and disc height with immediate postoperative measurements and measurements at a mean of eight months postoperatively. In no case was there an increase in kyphotic angle. Disc height remained within two mm of that shown on immediate postoperative radiographs.

We concluded that satisfactory results are obtained with variable screw plate fixation, with no compromised stability.