Instability of the neonatal hip: the role of early or late splintage

Abstract

From January 1992 to December 1997, 59 dislocatable hips (37 children), confirmed by ultrasound, were splinted by Pavlik bracing within 2 weeks of birth. The majority were splinted within 1 week. From January 1998 to December 1999, 16 dislocatable hips (11 children) were evaluated by ultrasound and were not initially splinted but were followed up by serial ultrasound. They were splinted if they did not spontaneously stabilise on ultrasound. None of those patients treated by immediate splintage between 1992 and 1997 have subsequently required surgical intervention. Two of the infants treated between 1998 and 1999 (12% of the hips) later required a surgical procedure on the hip joint or proximal femur (p=0.049, Fisher's exact test). Nine out of 16 hips required splintage at a later date. We would not advocate delayed observation by ultrasound of unstable hips after 2 weeks of age. A clinically unstable hip should be assessed by ultrasound within 2 weeks of birth. If it is unstable on ultrasound, it should be splinted for 6 weeks. There is no need to wean off the splint.