2006; 77 (2): 257–261 257
6 weeks with the von Rosen splint is sufﬁcient for treatment of neonatal hip instability
, Johan Gustafsson
and Gunnar Hägglund
Radiology, Lund University Hospital, Lund, SwedenCorrespondence H L-P: Henrik.Lauge-Pedersen@ort.lu.seSubmitted 04-10-18. Accepted 05-09-25
Copyright© Taylor & Francis 2006. ISSN 1745–3674. Printed in Sweden – all rights reserved. DOI 10.1080/17453670610045993
BackgroundThere is no concensus on the optimal treat-ment time for unstable hips in the newborn. We analyzedthe efﬁciency of a treatment program that has been usedfor 10 years at our hospital, in which all unstable hips(subluxatable, Barlow-positive and Ortolani-positive)are treated with the von Rosen splint for 6 weeks.Patients and methodsBetween 1988 and 1997, 32,171children were born alive at the hospital. During thisperiod 247 children had a clinically unstable hip diag-nosed. 223 of the 247 children underwent a radiographicfollow-up after 5–15 years.Results1 patient with bilateral instability and treatedwith a splint for 6 weeks showed a dislocated left hip atthe radiographic examination at 8 months, which is partof the screening program, and needed operative treat-ment. 1 patient did not follow the treatment programand showed a dislocated hip at the age of 3. Another 4patients required more treatment than the 6 weeks withthe splint.We found no dysplastic hips at the radiographicfollow-up. There was no late dysplasia and there were nolate dislocations in children born in Lund between 1988and 1997 who were diagnosed at other Swedish centersthat treat developmental dysplasia of the hip (DDH).InterpretationWe conclude that the present screen-ing and 6-week treatment in a von Rosen splint preventalmost all cases of late dysplasia and late dislocation of the hip.
It is generally accepted that early treatment of Neo-natal Instability of the Hip (NIH) prevents disloca-tion (Palmen 1984). There are, however, variationsin the screening procedure, the splinting technique,the duration of splinting, and the follow-up routines(Emneus 1966, Fredensborg 1976, Palmen 1984,Sahlstrand et al. 1985, Krikler and Dwyer 1992).We analyzed the efﬁciency of a treatment programthat has been used for 10 years in Lund, Sweden,in which subluxatable (unstable, but not dislocat-able) and Barlow-positive and/or Ortolani-positivehips are treated with the von Rosen splint (Figure1) for 6 weeks. With this program, we reduced thetreatment time in the von Rosen splint from 12 to6 weeks and sonography was introduced as a diag-nostic tool for NIH.
Patients and methods
During the 10-year period 1988–1997, 32,171children were born alive at the University Hospitalin Lund. The pediatricians routinely examined allhips during the ﬁrst days of life, and those hipsthat were judged to be unstable were referred for
Figure 1. The von Rosen splint.
A c t a O r t h o p D o w n l o a d e d f r o m i n f o r m a h e a l t h c a r e . c o m b y 1 6 8 . 1 7 6 . 5 . 1 3 6 F o r p e r s o n a l u s e o n l y .