[Congenital dislocation of the hip in the newborn].

Though it has long been recognised that the earlier treatment for congenital dislocation of the hip is started the better is the result, it is only quite recently that serious efforts have been made to recognise the condition at birth. A clinical method of diagnosing congenital dislocation of the hip first described by Ortolani (1937) has been used in Northern Italy for many years, but until von Rosen (1962) published his results only lip service was paid elsewhere to the diagnosis of hip dislocation in the newborn. Even now most orthopaedic textbooks emphasise only the classical signs of congenital dislocation of the hip and if it is mentioned at all Ortolani’s test is usually described incorrectly. In New Zealand it has been the practice in a few hospitals for all newborn babies to be examined for hip dislocation as part of a general physical examination. This examination is carried out by a variety of examiners, some more skilled than others. All babies in this country are born in maternity hospitals varying in size from about twelve beds to the larger units attached to general hospitals. Most of these babies are delivered by general practitioners and there is a wide variation in the number of deliveries each doctor does in a year and in the thoroughness of the examination of the babies delivered by him. The present study was made of babies born in the maternity unit attached to Wellington Hospital. Fourteen per cent of these babies were delivered by members of the obstetric unit, the remainder by forty-five different doctors. Those deliveries done by the obstetric unit were either in unbooked cases or where some complication had arisen in pregnancy or labour necessitating specialist obstetrical management. From February 1963 to April 1966 the author personally examined the hips of all 6,000 babies born at this hospital. For the first 2,100 babies clinical examination of the hips was carried out once weekly, so the babies ranged in age from none to seven days. In the first few months of the survey it was the author’s policy to defer examination when a baby appeared to be very frail or ill until its condition had improved. As will be seen later, this proved to be unwise. The later 3,900 babies were seen at examinations conducted twice weekly, so that the babies ranged in age from none to four days.