[Hip screening in newborn infants. Clinical and ultrasound results].

Abstract

A routine orthopaedic examination of each newborn was performed at the Salzburger Landesfrauenklinik (Department for gynaecology and obstetrics) since 1964. The results of these examinations were stored in an electronic database since 1978 and were now evaluated in a retrospective analysis. The examinations were performed by 8 orthopaedic surgeons between I/1978 and IX/1984. 5.9 percent of all newborns had a limited abduction and 13.2 percent a lax hip. Hips with limited abduction and lax hips were not classified as pathological but were recommended for strict observation and X-ray control at an age of four months. A similar rate of instable hips such as subluxatable (= 2.11%) and luxatable (= 0.63%) hips were also observed by other authors, whereas quite lower rates of instable hips in newborns were reported from several other European parts. Mau indicated the limited value of clinical examinations particularly when evaluating data in a multicenter study was concerned. In our study each examiner had a statistically significant variation of his results which we found by establishing an examiners ratio (Formula: see text). Since October 1984 the clinical routine newborn screening was completed by an obligatory hip sonography in the first days of life. The sonographic examination and classification was done according to Graf's method. Real-time ultrasound machines with linear 5 MHZ-transducer were used. 8.221 newborns were examined between X/1984 and XII/1988. 72.51 percent were type Ia, b. 25.63% were categorized as type IIa; 1.66 percent were classified type IIc, D; 0.16 percent were type IIIa hips. Only one hip was classified as type IV, this was a teratological dislocated hip. 1.31 percent of all hips showed a pathologic sonogram (= type IIc, D, IIIa) without having shown abnormalities, when clinically examined a few days before. In our opinion these results emphasize the value of a sonographic newborn screening. The majority of hips with distinct abnormalities only (= lax hips, limited abduction) was type Ia, b, or IIa, whereas the majority of clinical instable hips had pathologic sonograms (= IIc, D, IIIa). Newborns delivered by breech presentation had a significant higher percentage of clinically abnormal hips (= 7.48 subluxatable and luxatable hips). The percentage of pathologic sonograms (8.81%) and type IIa-hips (= 42.78%) was significantly higher compared to the normal delivered group. 336 premature newborns were found to have a statistically significant higher percentage of type Ia, b-hips (= 82.73%) and a statistically equal percentage of sonographically pathologic hips (= 0.89%) in comparison to the mature newborns.(ABSTRACT TRUNCATED AT 400 WORDS)