title: Early treatment with the von Rosen splint for neonatal instability of the hip is safe regarding avascular necrosis of the femoral head: 229 consecutive children observed for 6.5 years.
abstract: OBJECTIVE
  Avascular necrosis of the femoral head (AVN) is a complication in treatment of developmental dysplasia of the hip (DDH). We evaluated the risk of AVN after early treatment in the von Rosen splint and measured the diameter of the ossific nucleus at 1 year of age.
  
  
  METHODS
  All children born in Malmö, Sweden, undergo clinical screening for neonatal instability of the hip (NIH). We reviewed 1-year radiographs of all children treated early for NIH in our department from 2003 through 2010. The diameter of the ossific nucleus was measured, and signs of AVN were classified according to Kalamchi-MacEwen. Subsequent radiographs, taken for any reason, were reviewed and a local registry of diagnoses was used to identify subsequent AVN.
  
  
  RESULTS
  229 of 586 children referred because of suspected NIH received early treatment (age ≤ 1 week) for NIH during the study period. 2 of the 229 treated children (0.9%, 95% CI: 0.1-3.1) had grade-1 AVN. Both had spontaneous resolution and were asymptomatic during the observation time (6 and 8 years). 466 children met the inclusion criteria for measurement of the ossific nucleus. Neonatally dislocated hips had significantly smaller ossific nuclei than neonatally stable hips: mean 9.4 mm (95% CI: 9.1-9.8) vs. 11.1 mm (95% CI: 10.9-11.3) at 1 year (p < 0.001).
  
  
  CONCLUSIONS
  Early treatment with the von Rosen splint for NIH is safe regarding AVN. The ossification of the femoral head is slower in children with NIH than in untreated children with neonatally stable hips.
authors.affiliation: a Department of Orthopedics , Skåne University Hospital , Malmö , Sweden .|b Department of Clinical Sciences , Lund University , Malmö .
authors.forename: Daniel
authors.initials: D
authors.lastname: Wenger
authors.affiliation: c Faculty of Medicine , Lund University , Sweden.
authors.forename: Hanna
authors.initials: H
authors.lastname: Samuelsson
authors.affiliation: a Department of Orthopedics , Skåne University Hospital , Malmö , Sweden .|b Department of Clinical Sciences , Lund University , Malmö .
authors.forename: Henrik
authors.initials: H
authors.lastname: Düppe
authors.affiliation: a Department of Orthopedics , Skåne University Hospital , Malmö , Sweden .|b Department of Clinical Sciences , Lund University , Malmö .
authors.forename: Carl Johan
authors.initials: CJ
authors.lastname: Tiderius
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D010012:Osteogenesis / Q000502:physiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011859:Radiography; D013165:Splints / Q000009:adverse effects*; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome