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SCREENING AND EARLY MANAGEMENT OF DDH

Orthopaedic Dept, Women’s and Children’s Hospital, Adelaide, Australia

The MRC Working Party (United Kingdom) on CDH recently reported an ascertainment adjusted incidence of a first operative procedure for CDH of 0.78 per 1,000 live births, similar to the incidence before the commencement of the U.K. Screening programme. It also found that 70% of cases had not been detected before 3 months of age.

South Australia has had a similar clinical screening programme since 1964. This study determined the incidence of an operative procedure for CDH in the first 5 years of life among children born in South Australia between 1988 – 1993 (118,379 live births in total) and the proportion detected after 3 months of age.

Of 47 children identified as having non-teratologic DDH and operative procedures, 24 were diagnosed before one month of age. Some required operative intervention beyond 3 months of age despite early diagnosis. Only 22 (46.8%) had been diagnosed at or after 3 months of age 18 of the 47 had an open reduction and/or osteotomy while the remainder had arthrograms, closed reductions and/or tenotomy

The prevalence of non-teratologic DDH was 7.7 per 1,000 live births. The incidence of surgery in the first 5 years of life was 0.40 per 1,000 live births and only 0.19 per 1,000 for those late diagnosed at or after 3 months.

These results demonstrate that a screening programme can be successful, contrary to the findings of the UK MRC Working Party.

The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.