Between 1978 and 1997 all newborns in the Austrian province of Tyrol were reviewed regarding hip dysplasia and related surgery. This involved a mean of 8257 births per year (7766 to 8858). Two observation periods were determined: 1978 to 1982 (clinical examination alone) and 1993 to 1997 (clinical examination and universal ultrasound screening). A retrospective analysis compared the number and cost of interventions due to hip dysplasia in three patient age groups: A, 0 to < 1.5 years; B, ≥ 1.5 to < 15 years; and C, ≥ 15 to < 35 years.

In group A, there was a decrease in hip reductions from a mean of 25.2 (sd 2.8) to 7.0 (sd 1.4) cases per year. In group B, operative procedures decreased from a mean of 17.8 (sd 3.5) to 2.6 (sd 1.3) per year. There was a 75.9% decrease in the total number of interventions for groups A and B.

An increase of €57 000 in the overall cost per year for the second period (1993 to 1997) was seen, mainly due to the screening programme. However, there was a marked reduction in costs of all surgical and non-surgical treatments for dysplastic hips from €410 000 (1978 to 1982) to €117 000 (1993 to 1997). We believe the small proportional increase in costs of the universal ultrasound screening programme is justifiable as it was associated with a reduction in the number of non-surgical and surgical interventions. We therefore recommend universal hip ultrasound screening for neonates.

Aims. The aim of this study was to review the value of accepting referrals for children with ‘clicky hips’ in a selective screening programme for hip dysplasia. Patients and Methods. A single-centre prospective database of all referrals to the hip clinic was examined to identify indication for referrals, diagnosis, and treatment. All patients referred received a standardized ultrasound scan and clinical examination by an orthopaedic consultant. Results. There were 5716 children referred to the orthopaedic hip clinic between 1 June 2014 and 26 September 2018. In all, 1754 children (30.1%) were referred due to ‘clicky hip’ with no additional risk factors or indications for ultrasound scan. A total of 123 children (7.1%) referred with ‘clicky hip’ and no additional risk factors or examination findings had an abnormal initial hip ultrasound, including 16 children (0.9%) with dysplastic hips. Of the 141 children who required treatment in a Pavlik harness during the study period, 23 (16%) had been referred with a ‘clicky hip’ and no additional risk factors or examination findings, including six children with Graf 3 or 4 hips. Conclusion. There is significant value in reviewing children with an isolated ‘clicky hip’. Many children who require treatment are referred to the orthopaedic service as ‘clicky hip’ with no additional risk factors. In a pragmatic pathway with a diverse population of clinicians performing baby checks, ‘clicky hip’ is an important indication for referral and should not be discarded. Cite this article: Bone Joint J 2019;101-B:635–638

Purpose. To clarify the true association with pathological DDH and ASC (asymmetrical skin crease). Method. Between 1. st. January 1995 and 31. st. December 2015 all paediatric referrals with suspected hip instability were assessed in a one-stop DDH clinic. All patients had clinical and sonographic assessment with results prospectively recorded onto a database. Result. Over this 21-year period, 103 cases were referred with ASC. Seventy were female and 33 male. The age distribution at initial assessment was bimodal with peaks at 3 and 9 months. Eighty-three cases (81% ) were referred with ASC, but the hip joints were normal on both clinical examination and sonography. Eighteen cases (17% ) were referred with ASC but had an additional risk factor. This group also had normal hips on both clinical examination and sonography. Of the 103 cases, only two had pathological DDH. Both were female and aged 3 and 10 months respectively. They had ASC, but in addition had unilateral limitation of hip abduction, a Galeazzi positive sign and a leg length discrepancy. Radiological assessment diagnosed unilateral irreducible hip dislocations in both cases. Statistical analysis calculated an overall sensitivity for ASC of 100% and a PPV of 1.94% . Conclusion. Public Health England NIPE guidelines state that ASC are a ‘screen positive sign’ and should be referred for expert assessment of the hip joints to exclude DDH. This study confirms the opinions of experts and systemic reviews that isolated ASC is an unreliable clinical sign in the diagnosis of pathological DDH. If the hip joint is clinically normal it is highly unlikely that there will be an association with pathological DDH. Routine radiological and sonographic imaging of the hip joints is unnecessary if there is no limitation of hip abduction and normal leg lengths (negative Galeazzi). National guidelines should reflect this

Purpose. There is concern that the positive predictive value (PPV) of neonatal screening for instability may have deteriorated over recent years, this study aims to evaluate this. Method. This is a prospective observational longitudinal study from 2012 – 2016. Patients that were referred from paediatric neonatal screening with hip instability (Ortolani / Barlow positive, clunks) were identified and underwent ultrasound and clinical examination in the one stop hip clinic by the senior author. Referrals were taken from a range of screeners from paediatric doctors to midwives and advanced neonatal practitioners. Syndromic or neurological dislocated hips were excluded. The outcome measures were the presence of a subluxated / dislocated hip on ultrasound as per Graf and Harcke classification and a positive provocative manoeuvre on examination. This allowed a PPV to be evaluated for both ultrasound and clinical examination. Results. 139 neonates were referred for a suspected dislocated or dislocatable hip from paediatric screening services. These were seen at a mean 14.0 days (95% C I, 12.28 to 15.72). 20 patients had a Graf type 4 hip on ultrasound and 5 had a positive provocative test on examination. This represents an ultrasound PPV of 14.4% and clinical exam PPV of 3.6% . This has deteriorated from 15 year data from our unit (PPV 24% clinical, 49% sonographic). Our overall surgical rate for DDH has increased to 1.07 per 1000, and our overall rate of open reductions has increased to 0.7 per 1000. This is based upon figures from 2012 – 2014. Conclusion. The PPV of screening has decreased over the last 5 years. The concern is too many screeners who, with regards screening the paediatric hip, are poorly trained, inexperienced, not adequately supervised. We need to learn the lessons of Sweden and ensure better quality screening by limiting screening to a small number of experienced practitioners

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%.

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There is a lack of high-quality research investigating outcomes of Ponseti-treated idiopathic clubfeet and correlation with relapse. This study assessed clinical and quality of life (QoL) outcomes using a standardized core outcome set (COS), comparing children with and without relapse.

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A national screening programme has existed in the UK for the diagnosis of developmental dysplasia of the hip (DDH) since 1969. However, every aspect of screening and treatment remains controversial. Screening programmes throughout the world vary enormously, and in the UK there is significant variation in screening practice and treatment pathways. We report the results of an attempt by the British Society for Children’s Orthopaedic Surgery (BSCOS) to identify a nationwide consensus for the management of DDH in order to unify treatment and suggest an approach for screening.

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The aim of this study was to determine the consensus best practice approach for the investigation and management of children (aged 0 to 15 years) in the UK with musculoskeletal infection (including septic arthritis, osteomyelitis, pyomyositis, tenosynovitis, fasciitis, and discitis). This consensus can then be used to ensure consistent, safe care for children in UK hospitals and those elsewhere with similar healthcare systems.

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Radiological residual acetabular dysplasia (RAD) has been reported in up to 30% of children who had successful brace treatment of infant developmental dysplasia of the hip (DDH). Predicting those who will resolve and those who may need corrective surgery is important to optimize follow-up protocols. In this study we have aimed to identify the prevalence and predictors of RAD at two years and five years post-bracing.

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Developmental dysplasia of the hip (DDH) can be managed effectively with non-surgical interventions when diagnosed early. However, the likelihood of surgical intervention increases with a late presentation. Therefore, an effective screening programme is essential to prevent late diagnosis and reduce surgical morbidity in the population.

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We investigated the prevalence of late developmental dysplasia of the hip (DDH), abduction bracing treatment, and surgical procedures performed following the implementation of universal ultrasound screening versus selective ultrasound screening programmes.

We present the long term outcome from children with Legg-Calves-Perthes (LCPD) treated at our unit. Patients treated for LCPD were identified retrospectively from an orthopaedic database between 1990 and 2005. Patient demographics, clinical examination, treatment and Herring classification were recorded at initial presentation and treatment. Long-term clinical and radiological follow-up was also recorded. 85 patients were identified and 4 excluded due to insufficient data giving a total of 81 patients. Of these, 58 were male and 23 female. Average age range at presentation was 6.5 years (range 1.5–14 yrs). The side affected was 34 right, 35 left, 24 bilateral giving 93 hips in total. Time between presentation and diagnosis averaged 4.7 months (range 0–48 months). In patients with recorded clinical examination 87% had reduced abduction and 88% reduced internal rotation. Treatment was largely conservative with 12 hips (13%) undergoing surgery within the first 4 years of diagnosis. Radiographs were available for 71 hips. Herring classification was A-12, B-22, C-37. Long term follow up averaged 16 years (range 10–25 yrs). Stulberg grading was available in 67 hips; Grade I 13, Grade II 21, Grade III 19, Grade IV 18 and Grade V 6. There were ongoing issues (mostly pain) in 18 hips, 5 of which required a subsequent operation. No correlation was found between abduction and Stulberg grade (p-value = 0.7). A correlation was found between delay in diagnosis of ≥6 months and the need for a subsequent operation (p-value = 0.0408). The overall trend as expected showed that a better Herring classification generally led to a more favourable Stulberg classification. Range of motion was not predictive for Stulberg grade. The need for further surgical intervention for symptoms at long term follow up was 0.05%

Aims

Studies of infant hip development to date have been limited by considering only the changes in appearance of a single ultrasound slice (Graf’s standard plane). We used 3D ultrasound (3DUS) to establish maturation curves of normal infant hip development, quantifying variation by age, sex, side, and anteroposterior location in the hip.

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Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate a novel screening programme that included both the primary risk factors of breech presentation and family history, and the secondary risk factors of oligohydramnios and foot deformities.

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Children with spinal dysraphism can develop various musculoskeletal deformities, necessitating a range of orthopaedic interventions, causing significant morbidity, and making considerable demands on resources. This systematic review aimed to identify what outcome measures have been reported in the literature for children with spinal dysraphism who undergo orthopaedic interventions involving the lower limbs.

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Brace treatment is the cornerstone of managing developmental dysplasia of the hip (DDH), yet there is a lack of evidence-based treatment protocols, which results in wide variations in practice. To resolve this, we have developed a comprehensive nonoperative treatment protocol conforming to published consensus principles, with well-defined a priori criteria for inclusion and successful treatment.

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The aim of this study was to gain a consensus for best practice of the assessment and management of children with idiopathic toe walking (ITW) in order to provide a benchmark for practitioners and guide the best consistent care.

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

Aims

There is no consensus regarding optimum timing and frequency of ultrasound (US) for monitoring response to Pavlik harness (PH) treatment in developmental dysplasia of the hip (DDH). The purpose of our study was to determine if a limited-frequency hip US assessment had an adverse effect on treatment outcomes compared to traditional comprehensive US monitoring.

Developmental dysplasia of the hip (DDH) should be diagnosed as early as possible to optimise treatment. The current United Kingdom recommendations for the selective screening of DDH include a clinical examination at birth and at six weeks. In Northern Ireland babies continue to have an assessment by a health visitor at four months of age. As we continue to see late presentations of DDH, beyond one year of age, we hypothesised that a proportion had missed an opportunity for earlier diagnosis. We expect those who presented to our service with Tonnis grade III or IV hips and decreased abduction would have had clinical signs at their earlier assessments. We performed a retrospective review of all patients born in Northern Ireland between 2008 and 2010 who were diagnosed with DDH after their first birthday. There were 75 856 live births during the study period of whom 645 children were treated for DDH (8.5 per 1000). The minimum follow-up of our cohort from birth, to detect late presentation, was four years and six months. Of these, 32 children (33 hips) were diagnosed after their first birthday (0.42 per 1000). With optimum application of our selective screening programme 21 (65.6%) of these children had the potential for an earlier diagnosis, which would have reduced the incidence of late diagnosis to 0.14 per 1000. As we saw a peak in diagnosis between three and five months our findings support the continuation of the four month health visitor check. Our study adds further information to the debate regarding selective versus universal screening. . Cite this article: Bone Joint J 2015;97-B:1572–6