Diagnosis and treatment of congenital dislocation of the hip in newborn infants in Jordan

ABSTRACT

Neonatal hip instability, its incidence, diagnosis, and treatment have been studied prospectively in obstetric sections in four hospitals for the period 1974 -1977. During this period, 10,128 newborns were examined personally. Only 6,972 infants were thoroughly evaluated. These children were examined during the first twenty four hours of life and again after three months of age when they were also x-rayed. Forty-seven children with hip instability were diagnosed by neonatal screening; one case was missed but was discovered after three months of age. The incidence was 6.9 per 1,000. All unstable hips were treated upon diagnosis with a Frejka splint. The results were uniformly good in all, but in two cases where a mild asymmetry of the ossification center of the femoral heads was seen, radiograms revealed normal hips two years later. The results of this investigation are compared with those from the literature. The incidence of instability and missed cases, the complications of treatment as well as the causes of discrepancy in various reports in the literature are discussed. Congenital dislocation of the hip occurs in sufficient numbers in Jordan to justify a greater interest in the early detection and proper treatment. Since the pioneer works of Le Damany[1] and Ortolani[2] the modern principles of early diagnosis and treatment have been gradually adopted in most countries. Especially in the last two decades increasing efforts have been made to diagnose early this crippling disease by routine examination of newborn infants. In spite of the good results obtained by the propagators of neonatal screening[3,5] failures have occurred both in the early diagnosis and early treatment with others[6,11]. In some reports, missed dislocations approximate the expected incidence of congenital dislocation of the hips[6,8,11]. On the other hand, it was demonstrated that most hip dysplasias, which are discovered in the first twenty four hours, tend to improve spontaneously. Because of this, the validity of neonatal screening was questioned[12]. Are we treating those hips which will cure themselves and are missing the real problem For this reason, a program of neonatal screening was set up with the following objectives: [a] to verify the validity of the concept of neonatal screening when an orthopedic surgeon carries out the examination; [b] to determine the incidence of congenital dislocation of the hip of newborn infants in Jordan; and [c] to find out if it were possible, by conservative means, to cure the infant completely [of congenital dislocation of the hip] when the treatment is commenced in the newborn