title: Open reduction for developmental dysplasia of the hip: failures of screening or failures of treatment?
abstract: BACKGROUND
  The aim of this study was to define the clinical indications and demographic characteristics of patients under-going open reduction for developmental dysplasia of the hip (DDH), and determine the proportion due to preventable failures of contemporary clinical screening and early management.
  
  
  METHODS
  Case notes were reviewed of consecutive primary open reductions performed for non-teratologic hip dislocation at the Great Ormond Street Hospital for Children over a five-year period. Forty-eight patients (64 hips) were suitable for inclusion. A telephone survey confirmed selective hip ultrasonography screening protocols were employed in all maternity hospitals in our referral base.
  
  
  RESULTS
  There were no cases of open reduction for unilateral DDH following Pavlik treatment commenced by six weeks of age, highlighting the importance of early detection and treatment. Eleven cases (23%) may have been avoided by appropriate implementation of existing selective ultrasonography screening protocols. Thirty-four cases (71%) presented after four months of age, suggesting open reduction is associated with late diagnosis rather than failure of primary management. None of these patients had neonatal hip ultrasonography and only 12% (4 patients) had a risk factor that should have triggered a scan.
  
  
  CONCLUSIONS
  Compared with published results, the contemporary screening practices in our referral base are failing to eliminate late presenting DDH and the need for open surgical reduction. Changes in strategy and implementation are required to significantly improve screening efficacy.
authors.affiliation: Norfolk and Norwich University Hospitals NHS Foundation Trust, UK. anish.sanghrajka@nnuh.nhs.uk
authors.forename: A P
authors.initials: AP
authors.lastname: Sanghrajka
authors.forename: C F
authors.initials: CF
authors.lastname: Murnaghan
authors.forename: A
authors.initials: A
authors.lastname: Shekkeris
authors.forename: D M
authors.initials: DM
authors.lastname: Eastwood
mesh_terms: D002675:Child, Preschool; D057210:Delayed Diagnosis; D042241:Early Diagnosis; D005260:Female; D006618:Hip Dislocation, Congenital / Q000175:diagnosis / Q000601:surgery*; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure