Systematic struggle to eradicate developmental displacement of the hip in newborns in the regions of Kula and Vrbas

Abstract

Introduction. Successful treatment of developmental displacement of the hip (DDH) depends on early diagnosis. Clinical screening of all newborns is a useful tool and should be encouraged in everyday practice, because DDH has a high prevalence and significant morbidity. Clinical exam is an important part of early diagnosis, but insufficient. Ultrasound exam is more sensitive in early diagnosis of DDH. Objective. Systematic struggle against DDH by means of early detection and treatment begins in neonatology units, and continues in primary healthcare centres. Methods. Methodology consists of personal history, clinical exam, ultrasonography and radiography. After these procedures, treatment is advised if necessary. Basically, DDH treatment is atraumatic involving abduction pillow, Von Rosen abduction device, Pavlik harnesses. Results. During 2007 and 2008, screening examination was performed in 769 boys (51.47%) and 725 girls (58.52%), born at the Medical Center ?Veljko Vlahovic? in Vrbas. A total of 1,494 neonates or 2,988 hips were examined. Ultrasonographically, a normal type Ia was found in 406 hips (13.60%), intermediate type Ib in 2,014 hips (67.40%), immature type IIa+ in 374 hips (12.50%), unstable type IIg in 39 hips (1.30%), decentering IId in 52 hips (1.70%), and eccentric types III and IV in 35 hips (1.20%). Of 2988 examined hips, normal finding was detected in 2794 (93.50%) and pathological finding (DDH) was found in 194 (6.50%). Ultrasonographical findings were determined according to Graph classification. Conclusion. The frequency of DDH in the regions of Vrbas and Kula above 5% (6.50%) presents a social and medical problem in children of these locations. Eradication, early detection and treatment involve systematic examinations (clinical, sonographical and radiographical) in the first year of life. Treatment has to be initiated in a neonatal unit by atraumatic means. The team work including a gynaecologist, neonatologist and paediatric orthopaedic surgeon is crucial.