ROLE OF ULTRASOUND ASSESSMENT AND HARNESS TREATMENT IN THE MANAGEMENTOF DEVELOPMENTAL DYSPLASIA OF THE HIP

The effect of the introduction of a programme combining clinical hip s creening supplemented by limited targeted ultrasound assessment on spl intage for developmental dysplasia of the hip (DDH) was evaluated over a 3-year period. The use of ultrasound is of both diagnostic and ther apeutic value as it allows monitoring of the effects of splintage and decreases the total treatment time required. In all, 82 dysplastic hip s were identified in 65 infants and the period of splintage averaged 6 .3 weeks (range 3-12 weeks). The overall splintage rate can also be re duced as hips with only minor dysplasia can be assessed by serial scan s until resolution or progression occurs rather than automatic treatme nt of all abnormal hips and in this series the rate was 6 per 1000 (0. 6%).The Wheaton-Pavlik harness is a dynamic lightweight splint which i s user friendly, easy to apply and adjust, and with no major complicat ions being encountered in this series. Unnecessary exposure to radiati on was reduced as plain radiographs were not performed before ossifica tion of the capital epiphysis; prolonged splintage was prevented and a weaning period from the brace was not used. All children remained und er follow-up for 1 year after the hips were confirmed to be clinically and radiologically normal and there were no cases of late re-dislocat ion or subluxation. There were no cases of avascular necrosis and a ma rkedly reduced need for diagnostic arthrograms, with only two being pe rformed during the 3 years. This regimen has resulted in a low rate of late presenting DDH requiring surgery of 0.28/1000, as well as a low splintage rate of 6/1000 (0.6%). Most of the improvement in the result s can be attributed to the more accurate evaluation of DDH by ultrasou nd, but the absence of avascular necrosis and other complications is l ikely to be due to the shorter period of time spent in a dynamic splin t without the use of excessive abduction.