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Controlled trial of immediate splinting versus ultrasonographic surveillance in congenitally dislocatable hips
1Institute of Child Health, Southmead Hospital, Bristol University, UK.
Insights
Congenital dislocation of the hip in infants can be safely monitored for two weeks using sonography, allowing for spontaneous resolution. This approach requires careful attention and resources but confirms the value of dynamic ultrasound in managing hip instability.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Neonatal Care
Background:
- Congenital dislocation of the hip (CDH) is a condition diagnosed in newborns.
- Early detection and management are crucial for optimal outcomes.
- The role of sonography in conjunction with clinical assessment requires further clarification.
Purpose of the Study:
- To evaluate the efficacy and safety of a 2-week sonographic surveillance strategy for infants with clinically diagnosed dislocatable hips.
- To compare outcomes between immediate splinting and delayed splinting based on sonographic findings and clinical stability.
- To assess the utility of dynamic sonography in the management of CDH.
Main Methods:
- A randomized controlled trial involving 79 infants with clinically dislocatable hips.
- Group 1: Immediate splinting (n=41).
- Group 2: Sonographic surveillance for 2 weeks, with splinting initiated if instability persisted or sonographic abnormality did not improve (n=38).
- Clinical and sonographic assessments were performed at birth, 2 weeks, 6 months, and 12 months.
Main Results:
- No significant differences in sonographic findings or clinical outcomes were observed between the immediate splinting and delayed splinting groups at any follow-up point.
- In the surveillance group, 11 infants required splinting due to persistent instability, and 4 due to lack of sonographic improvement.
- Dynamic sonography was confirmed as a valuable tool for clinical management.
Conclusions:
- A 2-week period of sonographic surveillance for dislocatable hips is a safe approach, allowing for potential spontaneous resolution.
- This management strategy necessitates significant resources and meticulous attention to detail.
- While sonography's low specificity in the first week limits its use as a primary screening tool, it is invaluable as an adjunct to clinical assessment and management of CDH.
Abstract:
79 infants with congenitally dislocatable hips diagnosed clinically soon after birth were examined sonographically and randomised in a controlled trial to immediate splinting (n = 41) or sonographic surveillance for 2 weeks (38). Infants from this second group were splinted at age 2 weeks if instability persisted (11 of 38) or if sonographic abnormality had shown no improvement (4 of 38). Sonographic findings or clinical outcome did not differ between the two groups at birth or at 6 and 12 months' follow-up. We conclude that dislocatable hips may be safely watched for 2 weeks after birth to allow spontaneous resolution, but that this approach requires considerable resources and attention to detail. Our experience confirms the importance of the dynamic sonographic scan. The low specificity (70%) of sonographic examination in the first week of life makes it an unsatisfactory primary method of screening at birth, but it is a most useful adjunct to the clinical screening and management of congenital dislocation of the hip.