Early recognition and functional treatment of hip dysplasia and dislocation

Abstract

After a brief introduction the author reports on the examination of hips in newborns and infants, dealing in particular with the "snap phenomenon" and von Rosen's success in Sweden. Ortolani's examination is described and conflicting opinions on radiological examination during the first weeks of life are discussed. Radiation doses measured by various authors are cited. In accordance with established practice in many countries, early treatment (in addition to early diagnosis) is recommended. In this context it is pointed out hat according to various authors, and also in the opinion of the author, inhibited abduction plays a major causal role in necrosis of the head of the femur. Inhibition of abduction should not be corrected by "brusque" treatment, since in the author's opinion this increases the incidence of head necrosis. It seems desirable to perform two preventive examinations of the newborn prior to discharge from the obstetric clinic; the first examination should take place during the first three to four days after birth. It would also seem desirable for the examination to be carried out conjointly by a pediatrician and an orthopedist. Since this is likely to remain a fond hope for the immediate future, the method practiced in Sweden is recommended. Since pediatricians usually perform preventive examinations in Germany, they should be made aware of the importance of the examination technique and of the desirability of consulting an orthopedic surgeon if findings are pathologic. Only close cooperation between pediatrician (or GP) and orthopedist can ensure a satisfactory result for all concerned. Apodietic demands should not be made.