The hips of 1000 newborn babies were examined clinically and by ultrasonography. The ultrasound assessment was based on measurements of the coverage of the femoral head by the bony acetabular roof, and this parameter was called the Bony Rim Percentage (BRP). The mean BRP was 55.3% in girls and 57.2% in boys, a significant difference. Clinical instability occurred in 0.7% of the newborn babies, and all of the unstable hips had a BRP below the lower limit of normal. All infants with normal clinical findings and suspected abnormal hips based on ultrasound were followed up; in all but two the hips became normal spontaneously. We conclude that ultrasonography, using the measurements of femoral head coverage, is appropriate for screening the newborn, is reliable in differentiating between a true and a false positive Ortolani sign, and that hip dysplasia which is not clinically demonstrable at birth can be detected by ultrasound. Ultrasound should replace radiography as the routine method of following up high-risk infants and those with suspicious signs

Fractures of the clavicle in the neonate are usually diagnosed by clinical examination and confirmed by plain radiography. Exposure of newborn infants to irradiation should be avoided if possible. Following the clinical examination of 2978 neonates, 15 had suspected fractures of the clavicle. All were confirmed by ultrasound. In combination with clinical examination, ultrasound is a satisfactory alternative to radiological assessment for the diagnosis of fractures of the clavicle in newborn children

Introduction: 1986 we started with ultrasound screening for congenital dislocation of the hip (CDH) in all newborn children from our hospital. In 1995 an regime was investigated we developed out of our expieriences of the previous years and started a prospective study. Material and methods: In the period 1995 to 2006 we did ultrasound screening in newborn babies within the first week of life. There were 14744 ultrasound checkups in 7372 children. Following the classification of Graf we had 7213 children with stage Ia,Ib or IIa. In 159 children (2,15%) we saw a ultrasound measurement stage IIc or worse (D,IIIa/b; IV a/b) which was an indication for treatment with the Pavlik bandage. Over all we treated 203 dysplastic hips with our regime. By dedecting a congenital dislocated hip we applyed the Pavlik harness immediately after diagnosis in 110 degrees of flection an 45 degrees of abduction. The fist controll reviewing the compliance of the parents and the setting of the bandage was 10 to 14 days after starting treatment. Every 10 to 14 days we did bandage checks combined with ultrasound controlls. We stopped treatment with the pavlik harness when the ultrasound showed a mature, well developed picture of both hips compared to Graf stage Ia/b. Results: We treated 159 newborn with 203 dislocated hips. There were 131 (82.4%) female an 28 (17.6)% male patients. 100 right (49.5%) and in 103 left (50.5%) hips. The distribution following Graf classification were 150 for typ IIc (73.9%), 18 for type D (8.9%), 31 for type IIIa/b (15.3%) and 4 type IVa/b (1.9%). Summerizing there were 150 hips, stage IIc (73,9%), to be at risk to develope an luxation, but 53 (26,1%) hips were already luxated at the moment of birth. The average treatment time over all was 53 days (7,6 (3–26) weeks). Subdividing the groups the treatment period for stage IIc was in mean 7.6 weeks, for stage D 7.1 weeks, for stage III a/b 9.5 weeks and for stage IV a/b 9 week. We had a lost to follow up in 4 (1,81%) patients (3 times compliance problems with the parents at stage II a in both sides). Once we had to treat with a so called Fettweiss-cast after one week of therapy because the baby was to small for the bandage but in the other cases there was no need für additional methodes of treatment. At no time we ever had a degradation of the disease. Furthermore we had no necrosis of the femoral head in our study population. Conclusion: The treatment with the Pavlik bandage of the CDH in every stage in newborn was possible and showed good result in 203 hips. To establish a standardised therapy you have to do an area-wide ultrasound screening as well as an consistently follow up of your therapy

1. Twenty-one cases of congenital dislocation of the hip were found on examination of 1,881 consecutive neonates on the first day of life, giving an incidence of eleven per 1,000 live births. 2. Insignificant high-pitched "clicks" were noted in 10 per cent of newborn children. 3. Conversion of half of the patients with hip dislocation to normal occurred during the first post-natal week. 4. Joint laxity was not a feature of the newborn with congenital dislocation of the hip. 5. Oestradiol, oestrone and oestriol were estimated in twenty-fourhour urine samples collected from sixteen patients with congenital dislocation of the hip and nineteen matched controls during the first six days of life. No significant differences in oestrogen output between the two groups were found. 6. The hypothesis that congenital dislocation of the hip is a result of an inborn error of oestrogen metabolism in the newborn is not supported

We have followed the natural progress of newborn infants in whom ultrasound examination showed abnormalities in hips which appeared to be clinically normal. Over six years we saw 306 such children out of 9952 examined (31 per 1000 live births). The examination was repeated at two to three months and those who still showed an abnormality were followed up further. At four to five months a standard radiograph was obtained, and treatment began if this and another ultrasound scan were both abnormal. At this stage, 291 infants had normal hips. In the 15 infants with abnormal hips there was no pronounced deterioration, none developed a frank dislocation, and all became normal after treatment in an abduction splint. Newborn infants with abnormal and suspicious ultrasound findings who are normal on clinical examination do not need treatment from birth; most of these hips will settle spontaneously. Treatment can be postponed until the age of four to five months unless clinical instability develops or ultrasound shows dislocation. The criteria for treatment should be based on measurements by both ultrasound and radiography: both should show an abnormality before intervention is considered necessary

Introduction: Late diagnosed developmental dysplasia of the hip joint (DDH) is now a very rare case in an orthopaedic practice. It is mostly because of early ultrasound screenings of baby’s hips. Two ultrasound techniques are most popular and widely used in the world – the Graf’s technique in Europe and Harcke’s in the USA. The purpose of this study was to establish a value of Harcke’s technique which is not very popular in Europe. Material and Methods: During the last 10 years, 25 000 ultrasound hip examinations of newborns hips because of early DDH screening were performed in our Clinic. In every child both hips were examined using two techniques (Graf’s and Harcke’s). The mean age during the first hip ultrasound examination was 5 weeks (from 10 days to 8 weeks). The Siemens SL1 equipment with linear transducer of 7.5 MHz was used for examination. The position of the hip during examination followed all requirements indicated by Graf or Harcke. All ultrasound examination were performed and analyzed by two orthopaedic surgeons. Results: In this study the DDH was diagnosed in 5,6% of all examined hips. Most common type of dysplastic hip was type II according to Graf’s classification, or laxity with stress according to Harcke’s classification. The cases with decentration (subluxation or dislocation) were diagnosed in 2% of all dysplastic hips. In Graf’s technique there were some differences in measuring the beta or alfa angles between examiners, however, this did not influenced the type of hip dysplasia. Harcke’s method was easy to perform because the measuring of the angles was not necessary. The time which was required for examination of a child’s hips did not extend 2 minutes. Conclusions: Both methods are very useful in early diagnosis of DDH and could be used for general hip screening for newborn hips. Harcke’s method gives a better visualization of the hip in two planes and gives dynamic pictures

1. Dissections of the newborn child revealed that the psoas muscle is a lateral rotator of the hip in all positions but that this secondary action is much stronger when the limb is abducted. 2. It has also been shown that the iliacus portion of the muscle can contribute towards the completion of abduction movement. 3. An attempt has been made to reconcile these facts with the accepted concept of the action of the muscle in the adult. 4. The clinical significance is discussed

1. Six thousand consecutive newborn babies were personally examined by the author for congenital dislocation of the hip. Twenty-four cases were diagnosed and twenty-three treated. 2. Twenty-two of the twenty-three treated cases had excellent results after treatment in the von Rosen splint. 3. The baby should be five days old before a final decision is made as to whether treatment is necessary. 4. A further twenty-seven babies were found to have unstable hips. Eighteen of these were followed up and all were found to have developed normally without treatment. 5. The technique of examination is simple and quick but it is desirable that it should be carried out in each maternity unit by only one or two doctors

The Norwich Health District (population 400,000) has been studied during a five-year period in an attempt to assess the value of examination of the hip in the newborn. It is confirmed that complicated deliveries produce higher rates of neonatal instability. But, in sixteen out of the seventeen cases with hip dislocations diagnosed late, delivery had been normal. It is estimated that after normal deliveries, hospital doctors detect only 50%, and family doctors only 28%, of cases of instability of the hip. It is concluded: 1) that the problem of congenital dislocation of the hip will not be eliminated by neonatal examination alone, even if skill in clinical examination could be improved and maintained; 2) that repeated examinations should be considered mandatory until the child is walking. In this regard, the value of the sign of limitation of abduction requires study; 3) that the public should be made aware by an appropriate health education programme that the problem of congenital dislocation of the hip has not yet been solved

1. Four cases of facial paralysis from the incorrect use of Von Rosen or Barlow type splints are described. 2. Attention is drawn to the subcutaneous and therefore vulnerable position of the facial nerve in the newborn

We describe the results of a policy of highly selective splintage for CDH, using knee plasters. No child suffered because splintage was withheld. In those who were treated the results were satisfactory and the proportion who required a subsequent operation was extremely low. Avascular necrosis was not a significant problem. The method, although a little more time consuming, appears to offer significant advantages over current alternatives.

The findings in a child with bilateral congenital dislocation of the hips who died shortly after birth are described. The only significant abnormality present was redundancy of the capsular ligaments and elongation of the ligament of the femoral head. The relationship between the orientation of the femoral neck and of the acetabulum was within normal limits. The significance of these findings in relation to etiology and management are discussed.

Of the 30585 births (from 1997–2002) in the population served by our NHS trust, 2742 babies (8.96%) were referred to the hip screening clinic by the neonatologists and general practitioners. They were examined clinically and by US scans by the specialist consultants. The findings were documented prospectively. 233 hips were identified as abnormal by ultrasound scans (Graf). 45% (106) of these were normal on clinical examination. None of the hips identified as abnormal on clinical examination were normal on US scans. In 38% (88) clinical examination could not be reliably performed as the babies were tense.

Of the 1862 hips which were clinically normal, 106 (5.69%) had abnormal ultrasound findings. Furthermore, of the 841 babies who were tense on clinical examination, 88 (10.46%) babies had abnormal ultra-sonographic findings.

Ultrasound scanning of hips in at-risk babies by an experienced paediatric radiologist will identify all the abnormal hips. This will release the paediatric orthopaedic surgeon from routine clinical examination of all these babies. This time can be utilised for running other clinics. Babies found to have abnormal hips on US scanning may be seen by the orthopaedic surgeon for treatment and follow-up. Parents of babies with normal hip US scans may be reassured by a nurse practitioner or a paediatric physiotherapist.

Several authors have suggested that the final five weeks of gestation are a critical period for the development of the hip. In order to test the hypothesis that gestational age at birth may influence the development of the hip joint, we analysed the sonographic findings in 1992 hips (in 996 term newborns) with no risk factor for developmental dysplasia of the hip. The 996 infants were born at a mean gestational age of 39 weeks (37 to 41).

The mean bony roof angle (α), cartilage roof angle (β) and the distribution of the type of hip were compared between the 37th, 38th, 39th, 40th and 41st birth week groups. There was a significant difference in the distribution of type of hip between the different birth week groups (p < 0.001), but no significant difference between the α angles of all groups (p = 0.32). There was no correlation between birth week and roof angle (p = 0.407 and p = 0.291, respectively) and no significant correlation between birth weight and roof angle (p = 0.735 and p = 0.132, respectively).

The maturity of the infant hip, as assessed sonographically, does not appear to be affected by gestational age, and the fetal development of the acetabular roof appears to plateau from 37 weeks.

Cite this article: Bone Joint J 2013;95-B:266–70.

Aim: We wanted to ascertain if clinical examination confers any additional benefit to secondary/targeted ultrasound screening of neonatal hips.

Materials/Methods: Of the 30585 births (over a 6 year period) in the population served by our hospital, 2742 babies (8.96percent) were referred to the Hip Screening Clinic by the neonatologists and general practitioners. They were examined clinically and by US scans by the specialist consultants. The findings were documented prospectively. Of these, 1862 hips were normal on clinical examination, 841 hips tense (clinical examination inconclusive).

Results: 233 hips were identified as abnormal by the US scans (Graf method). 106 (45percent) of these were normal on clinical examination. In 88 of the hips with abnormal US scans (38percent), clinical examination could not be performed reliably as the babies were tense. None of the hips identified as abnormal on clinical examination were normal on US scans.

Conclusion/Discussion: US scanning of hips in at-risk babies by an experienced paediatric radiologist will identify all the abnormal hips. This will release the paediatric orthopaedic surgeon from routine clinical examination of all these babies. This time can be utilised for running other clinics. Babies found to have abnormal hips on US scanning may be seen by the orthopaedic surgeon for treatment and follow-up. Parents of babies with normal hip US scans may be reassured by a nurse practitioner or a paediatric physiotherapist. This should lead to better utilisation of resources and cost savings.

Aim: We wanted to ascertain if clinical examination confers any additional benefit to secondary/targeted ultrasound screening of neonatal hips.

Materials and Methods: Of the 30585 births (from 1997–2002) in the population served by our hospital, 2742 babies (8.96 percent) were referred to the Hip Screening Clinic by the neonatologists and general practitioners. They were examined clinically and by US scans by the specialist consultants. The findings were documented prospectively. Of these, 1862 hips were normal on clinical examination, 841 hips tense (clinical examination inconclusive).

Results: 233 hips were identified as abnormal by the US scans (Graf method). 106 (45 percent) of these were normal on clinical examination. In 88 of the hips with abnormal US scans (38 percent), clinical examination could not be performed reliably as the babies were tense. None of the hips identified as abnormal on clinical examination were normal on US scans.

Conclusion/Discussion: US scanning of hips in at-risk babies by an experienced paediatric radiologist will identify all the abnormal hips. This will release the paediatric orthopaedic surgeon from routine clinical examination of all these babies. This time can be utilised for running other clinics. Babies found to have abnormal hips on US scanning may be seen by the orthopaedic surgeon for treatment and follow-up. Parents of babies with normal hip US scans may be reassured by a nurse practitioner or a paediatric physiotherapist. This should lead to better utilisation of resources and cost savings.

Aims. The present study seeks to investigate the correlation of pubofemoral distances (PFD) to α angles, and hip displaceability status, defined as femoral head coverage (FHC) or FHC during manual provocation of the newborn hip < 50%. Methods. We retrospectively included all newborns referred for ultrasound screening at our institution based on primary risk factor, clinical, and PFD screening. α angles, PFD, FHC, and FHC at follow-up ultrasound for referred newborns were measured and compared using scatter plots, linear regression, paired t-test, and box-plots. Results. We included 2,735 newborns, of whom 754 received a follow-up hip ultrasound within six weeks of age. After exclusion, 1,500 hips were included for analysis. Sex distribution was 372 male and 380 female, and the mean age at examination was 36.6 days (4 to 87). We found a negative linear correlation of PFD to α angles (p < 0.001), FHC (p < 0.001), and FHC during provocation (p < 0.001) with a 1 mm increase in PFD corresponding to a -2.1° (95% confidence interval (CI) -2.3 to -1.9) change in α angle and a -3.4% (95% CI -3.7 to -3.0) change in FHC and a -6.0% (-6.6 to -5.5) change in FHC during provocation. The PFD was significantly higher with increasing Graf types and in displaceable hips (p < 0.001). Conclusion. PFD is strongly correlated to both α angles and hip displaceability, as measured by FHC and FHC during provocation, in ultrasound of newborn hips. The PFD increases as the hips become more dysplastic and/or displaceable. Cite this article: Bone Jt Open 2023;5(1):3–8