INSTABILITY OF THE NEONATAL HIP. A COMPARISON OF EARLY AND DELAYED SPLINTED

Abstract

Aim: To compare the results of early splintage against delayed splintage with ultrasound surveillance in neonatal hip instability.

Methods: Between 1992 and 1997, all unstable hips (Ortolani or Barlow positive) referred by the Paediat-ric Department were seen within 1 to 2 weeks of birth. They were assessed clinically and by static and dynamic ultrasound. Those with proven instability were treated in a Wheaton Pavlick splint. Between 1998 and 1999, with the same assessments made, all hips with proven instability were treated by close surveillance in the form of serial ultrasound and were splinted if there was persistent instability or dysplasia. Any neonate presenting later than 2 weeks was excluded from this study.

Results: From 1992 to 1997, 37 neonates were treated with 59 unstable hips. Mean time to splintage was 6.35 days (1-14 days), and mean splintage time was 6.13 weeks (4-11 weeks). All patients in this group developed normally, and no surgical intervention was required. From 1998 to 1999, 11 neonates were treated with 16 unstable hips. 9 hips required splintage after an average of nine weeks. 7 hips stabilised with no splintage. Two hips required surgical intervention, one for ‘late’ dislocation and one for persistent dysplasia. These results show a statistically significant difference for the two treatment groups. (p=0.04, Fishers exact test)

Conclusion: We conclude from these results that neonatal hip instability is best treated by splintage within two weeks of birth.