NEONATAL HIP DYSPLASIA -- MANAGEMENT BY LONG TERM NIGHT SPLINTING

Introduction: Hip dysplasia is a frequent sequel to neonatal hip dislocation, even after reduction. Ultrasound is helpful, but accurate assessment of the acetabulum and femoral head requires a single AP pelvic X-ray at six months, when sufficient ossification is present. Management involves holding the hips abducted in flexion for prolonged periods. A Pavlik Harness, applied under night clothes, will achieve this in neonates and young infants but is poorly tolerated in an older and more active baby. The role of a simple abduction splint, applied outside clothes, ongoing at night until dysplasia is corrected, is evaluated. Material: Between 2012 and 2018, a single AP pelvic X-ray was obtained at age six months on 32 infants where hip dysplasia was suspected. The presence of a sloping acetabular roof, delayed femoral head ossification or imperfect location, confirmed the diagnosis. Dysplasia was bilateral in 17 patients. Method: A simple Camp-type hip abduction brace, worn outside pajamas and at night only, was prescribed. This was continued until satisfactory resolution of hip dysplasia was achieved. Monitoring was obtained by a single AP pelvic hip X-ray, not repeated for a full six months. Results: The use of a brace outside night clothes was readily accepted. Night splinting was required for an average of eighteen months. Full correction of hip dysplasia was achieved in all except one hip that subsequently required a pelvic osteotomy. Conclusion: Ongoing night splinting, using a simple abduction brace outside pajamas, is acceptable to infants and parents. This effectively corrects infantile hip dysplasia and avoids subsequent surgery.