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Published on: February 5, 2019
Sonographic Assessment of Hip Swaddling Techniques in Infants With and Without DDH
Howard T Harcke1, Ali F Karatas, Susan Cummings
1Departments of *Medical Imaging †Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
Insights
Swaddling infants with restricted leg motion can increase hip instability and dislocation risk. Safe swaddling techniques that allow free movement are recommended to maintain hip health.
Area of Science:
- Pediatric Orthopedics
- Neonatal Care
- Medical Imaging
Background:
- Assessing infant hip health is crucial for early detection of developmental dysplasia of the hip (DDH).
- Swaddling is a common practice for infants, but its effect on hip positioning and stability is debated.
Purpose of the Study:
- To evaluate the feasibility of performing hip sonography on swaddled infants.
- To determine if different swaddling techniques impact hip position and dynamics in infants.
Main Methods:
- Dynamic hip sonography was used to examine 30 infants with suspected or diagnosed DDH.
- Infants were assessed in both swaddled and unswaddled positions, including those treated with a Pavlik harness.
- Sonographic criteria included femoral head position, hip instability, and range-of-motion restriction.
Main Results:
- Tight swaddling restricted leg flexion and abduction, leading to one hip dislocation in an unstable infant.
- Safe swaddling techniques allowing free leg movement showed no adverse effects on hip stability.
- Commercial swaddling products mildly restricted motion and altered hip position in some infants, particularly those in Pavlik harnesses.
Conclusions:
- Swaddling methods that permit a wide range of leg motion do not compromise hip stability in infants.
- Swaddling that restricts leg movement poses a risk for hip instability and can negatively impact DDH treatment.
- Caution is advised with infant swaddling, especially concerning techniques that limit leg mobility.
Background:
The purpose of this single-examination pilot study was to confirm the ability to perform hip sonography while swaddled and to ascertain whether the various swaddling techniques influenced hip position and dynamics.
Methods:
Dynamic sonography was used to evaluate 30 infants in both swaddled and unswaddled positions who were being seen in clinic for suspected or documented developmental dysplasia of the hip. A "treatment group" of 16 infants (32 hips) treated in a Pavlik harness and a "nontreatment group" of 14 untreated infants (28 hips) were studied.Criteria for comparing sonographic results between swaddled and unswaddled hip positions included femoral head position, instability, and range-of-motion restriction.
Results:
Tight swaddling with a blanket was applied in 11 "nontreatment group" cases (20 hips; in 2 cases, only 1 hip studied) and produced limited flexion and abduction. One unstable left hip dislocated when tightly swaddled. Safe swaddling technique in 12 cases (24 hips) showed no limitation of flexion and abduction of the legs and no change in stability by sonography. Commercial swaddling products appeared to mildly restrict leg motion in 14 hips, but there was no change in hip position in the "nontreatment group." However, the commercial swaddling products changed the hip position in 3 Pavlik harness cases.
Conclusions:
Swaddling techniques that allow a free range of leg motion may not affect hip stability in normal infants or those being treated with Pavlik harness. Swaddling with restricted leg motion increases potential for hip instability. Tight swaddling dislocated 1 unstable hip, and commercial swaddling products judged to apply only mild restriction of leg motion negatively impacted 3 cases being treated for developmental dysplasia of the hip with Pavlik harness. On the basis of this pilot study, we advise caution when swaddling infants, especially with techniques that restrict leg motion. Further study of the long-term effects of swaddling is warranted.
Level Of Evidence:
Level II.
