Abstract
Congenital Dislocation of the Hip (CDH) has been routinely screened for at birth using clinical tests since the early 60’s. In Edinburgh Macnicol (1) assessed the screening programme between 1962 to 1986. It particularly focussed on the change in incidence of late diagnosis when screening was undertaken by experienced staff in comparison to junior staff. The treatment of Orthopaedic conditions in children within the Edinburgh area was combined at the Royal Hospital for Sick Children in 1995. Therefore this paper aims to reassess the screening programme for CDH between 1995–1999 and compare it with the previously achieved results in the same population.
From 1 Jan 1995 to 31 Dec 1999 there were 34,597 live births at Edinburgh’s Maternity hospitals. An orthopaedic clinical assistant examined all infants within the first 24 hours with considerable experience in this field. In addition to the Ortolani and Barlow tests, skeletal and skin fold asymmetry, limitation of abduction and loss of the physiological flexion deformity present in the normal neonate were observed. FH, delivery and circumstances of the pregnancy were noted. Hips found to be clinically unstable were referred on to the CDH clinic where further assessment and ultrasound were performed in order to decide upon the further management of each child.
In 1995 there were 7179 live births, 2.93 of which were harnessed (incidence per 1000 births), 1.11 late diagnosis, (incidence per 1000 births) and 1.39 were operated upon (incidence per 1000 births).
In 1996 there were 7144 live births, 3.64 of which were harnessed (incidence per 1000 births), 1.40 late diagnosis, (incidence per 1000 births) and 1.82 were operated upon (incidence per 1000 births).
In 1997 there were 7065 live births, 2.12 of which were harnessed (incidence per 1000 births), 0.57 late diagnosis, (incidence per 1000 births) and 0.71 were operated upon (incidence per 1000 births).
In 1998 there were 6763 live births, 4.14 of which were harnessed (incidence per 1000 births), 0.59 late diagnosis, (incidence per 1000 births) and 0.30 were operated upon (incidence per 1000 births).
In 1999 there were 6446 live births, 6.12 of which were harnessed (incidence per 1000 births), 0.78 late diagnosis, (incidence per 1000 births) and 0.62 were operated upon (incidence per 1000 births).
Overall there were 34597 live births, 3.76 of which were harnessed (incidence pre 1000 births), 0.89 late diagnosis, (incidence per 1000 births) and 0.98 were operated upon (incidence per 1000 births).
The incidence of late diagnosis of CDH in Midlothian has increased from 0.5 per 1000 as reported by Macnicol between 1962–1986 to 0.89 per 1000 over the last 5 years. These results are clearly disappointing. Although Catford et al (2) has proposed that the incidence of CDH has been increasing this does not explain the size of the increase in late diagnosis seen. Further investigation is required in order to reduce this late presentation rate to that previously achieved.
The abstracts were prepared by Wing Commander T. P. S. Bhullar. Correspondence should be addressed to him at the Ministry of Defence Hospital Unit, Edith Cavell Hospital, Bretton Gate, Peterborough PE3 9GZ.
Refs:
1 Macnicol MF. Results of a 25-year screening programme for neonatal hip instability. J Bone Joint Surg1990:72-B: 1057–60. Google Scholar
2 Catford JC, Bennet GC, Wilkinson JA. Congenital hip dislocation: an increasing and still uncontrolled disability? Br Med J1982; 285:1527–30. Google Scholar
