An important research study conducted by IHDI was reported before release by the BBC after discussion with our co-investigator at the University of Southampton. [https://www.bbc.com/news/health-47735103]. The paper was published online in June and distributed in print in the September edition of the Journal of Pediatric Orthopedics. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458090/pdf/bpo-40-408.pdf] This paper was also recognized in the February, 2021 edition of the Journal of Bone and Joint Surgery as one of the most important studies published in the last two years.
Through a collaboration of IHDI physicians in several countries, it was conclusively determined that newborn clinical exam is inadequate to detect all cases of infant hip dislocations, even when examined by expert and experienced pediatric orthopedic surgeons. This multinational study showed that approximately 14% of newborn hip dislocations are not discoverable by examination alone. Ultrasound confirmed the diagnosis when performed because of risk factors or positive exam findings on one hip but not on the opposite side that was also discovered to be dislocated when the ultrasound included both hips.
You might ask, “How can this happen?” but the participants discovered that some infants maintain full hip movement even when the hip is completely dislocated and remains outside the socket. The traditional Ortolani test depends on feeling the “clunk” when the hip is moved over the rim of the socket and falls into place. Reviewing Ortolani’s original report (published in Italian), he called attention to the fact that this feeling – like a wheel rolling over a speed bump – is not detectable in the most severe cases of dislocation when the hip remains outside the socket and does not fall into place during the examination.
Many “missed” or “late-diagnosed” hip dislocations do not have risk factors, or do not have one hip that is easily discovered during newborn examination. This study helps explain why so many infantile dislocated hips continue to be discovered after early infancy when treatment is generally much simpler. This study also provides strong support for screening that used modern technology instead of relying on clinical examination of newborn infants. The IHDI is supporting research for development of bedside hand-held ultrasound devices and acoustical detection systems that may be less expensive and more widely available than full-scale ultrasound examination that requires expensive equipment and considerable technical expertise. These simpler devices are still several years in the future, but they are possible and only need funding to push this ahead. You can help by donating any amount to this effort through the IHDI website.
