Radiologie Diagnosis of Prenatal Congenital Hip Dislocation and Subluxation in the Newborn

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Abstract
Controversy over the possibility of radiological diagnosis of congenital hip dislocation and subluxation in the new-born is well known (1, 2). It was this divison of opinion that stimulated the author's curiosity and led in 1958 to initiation of the study to be reported here. During the period 1958–1961 the author examined personally 5,000 newborn infants between the second and sixth day of age and dissected the hips of 120 who were stillborn or lived for only a few hours. All this material was used for roentgeno-graphic, clinical (6–9), and anatomico-pathologic (5) studies. Roentgen Study of Normal Hips in the Newborn and Stillborn To establish roentgenographic criteria for this study, roentgenograms were obtained of 450 newborn babies who had clinically normal hips. This group was followed in the clinic for twelve months and in none did subluxation or dislocation of the hips develop. The hips of 120 still-born and newborn babies were dissected and in 115 were found to be completely normal. These also were examined radio-graphically. Radiographs of normal hips in newborn and stillborn babies were found to have the following characteristics: 1. The average value of the acetabular index was 28°, ranging from 10° to 38°. 2. All radiographs of normal hips showed a protuberance—“acetabular beak”—on the superior lateral margin of the acetabular roof (Fig. 1). 3. Three radiographs of normal hips were taken, with the sacrum completely flat on the table and with the sacrum tilted anteriorly 15° and then 25° (“tilted anteriorly” means pelvic extension relative to the lumbar spine). On the three radiographs the value of the acetabular index and the form of the “acetabular beak” were almost unchanged (Figs. 2, 3, and 4). 4. Push-pull radiographs in stillborn and newborn babies with normal hips showed the same caudal-cephalad level of the proximal end of the femur as radiographs taken without the maneuver. Dissection of the hips of the stillborn and newborn group, numbering 120, disclosed 2 prenatal dislocations, 3 prenatal subluxations, and 3 prenatal dysplasias. This study included only babies who did not have any associated congenital anomaly. Prenatal Superoposterior Dislocation in the Stillborn Radiographic characteristics of superoposterior prenatal congenital dislocation of the hip were as follows: Acetabular index was within normal limits and “acetabular beak” was present— but smaller than in the normal acetabulum on roentgenograms taken with the pelvis flat on the table and on those tilted anteriorly 15 ° and 25 °. Push-pull films of the same hip showed the dislocation clearly (Figs. 5 and 6). The clinical examination of this hip prior to dissection revealed a positive telescoping sign. Ortolani's sign was negative. There was no limitation of abduction of the thighs. Prenatal Dislocation Op The Hips in the Newborn

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