title: To swaddle, or not to swaddle? Paleoepidemiology of developmental dysplasia of the hip and the swaddling dilemma among the indigenous populations of North America.
abstract: OBJECTIVE
  Clinical prevalence of developmental dysplasia of the hip (DDH) is high among modern indigenous populations of North America, yet no systematic study of the paleoepidemiology of this group exists. This study discusses the skeletal criteria, epidemiology, pathophysiology, and risk factors of DDH. A range of cases of DDH from an archaeological Native American population are described and the clinical and prehistoric prevalence of DDH among indigenous populations of North America are calculated and discussed within a biocultural perspective.
  
  
  METHODS
  Pelves of 390 adults from the Late Prehistoric (1490 B.P. ± 70) Buffalo site, West Virginia, were examined for DDH. Morphology of true and false acetabula was classified and other changes of the pelvis, lower limb, and spine were noted along with cranial deformation, providing evidence of infant restriction. Prevalence of DDH among living and archaeological indigenous peoples of North America were calculated and compared. Cranial deformation was assessed as evidence for swaddling.
  
  
  RESULTS
  DDH was identified in 18 adults from Buffalo, resulting in a minimum prevalence of 46.15 per 1,000, within the range reported in modern indigenous groups in North America. Most, but not all, of the DDH cases were associated with cranial deformation, but not all cases of cranial deformation were associated with DDH.
  
  
  CONCLUSIONS
  The etiology of DDH suggests that components of both genetic predisposition and swaddling practices have combined to create a high-risk environment for the development of DDH, contributing to high prevalence within archaeological populations, like Buffalo, and modern Indigenous groups of North America.
authors.affiliation: Department of Anthropology, Boise State University, Boise, Idaho, 83725-1950.
authors.forename: Samantha H
authors.initials: SH
authors.lastname: Blatt
mesh_terms: D000293:Adolescent; D000328:Adult; D001106:Archaeology; D003020:Clothing / Q000009:adverse effects*; D005260:Female; D005580:Fossils; D006617:Hip Dislocation / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007198:Indians, North American; D007223:Infant; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D014903:West Virginia / Q000453:epidemiology; D055815:Young Adult