Universal screening versus Selective screening for DDH

Developmental Hip Dysplasia (DDH), is an orthopaedic condition where the hip joint doesn't develop properly in infants and young children.  This can cause a range of issues from a loose joint to a completely dislocated joint.  Understanding of this condition is crucial for early diagnosis and effective treatment.

The exact cause of DDH is not completely understood, but many factors are known to contribute:

1. First degree family history of DDH (mother, father or siblings)
2. Breech births. 

Symptoms and diagnosis

1. early diagnosis is critical, one or more clinical abnormality
2. leg length discrepancy
3. range of abduction
4. Positive Barlow
5. Postive Ortanoli  (used up to usually 4 months of age).

All infants in the United Kingdom receive a new born physical examination within 48 hours of life and again followed up in the community by a Midwife, Health visitor, GP or any other health professional who is qualified to do so.

If an abnormality or a risk factor is identified an ultrasound of hips (USS) is requested and reviewed by a specialist in this field. Treatment under four months of age is usually a Pavlik Harness ( this is a soft brace that helps treat DDH by keeping the infant hips and knees apart), or if the case is to severe surgery will be discussed.  With early detection and appropriate management, most children with DDH lead a normal life, untreated and severe cases may lead to complications such as osteoarthritis, chronic pain and gain abnormalities later in life. 

Already, many parts of Europe have adopted universal screening, all infants receive a USS of hip unless an abnormality is picked up at an earlier examination. Some countries complete one at one week of life, six weeks of life and one at sixteen weeks of life. There is lots of discussion around what of what is the Gold standard for DDH. Currently there isn't one.

I am passionate about setting this standard #orthonursing #DDH.