Congenital Dislocation of the Hip in Newborns in the City of Mashhad

Background: Developmental dysplasia of the hip (DDH), formerly known as congenital dislocation of the hip (CDH) is a common congenital malformation which occurs worldwide with variable frequencies in respect to the race and geographic distribution.   Objective: To determine the incidence of DDH, its predisposing factors and the diagnostic value of click for its detection.  Methods: In a cross-sectional study of over 9-month duration, all of neonates born in the four teaching hospitals of Mashhad were examined during 48 hours after birth by Ortolani test.  For all newborns with unstable joints, data regarding maternal history were collected.  If clunk was felt on the first examination or click on repeated examinations, sonography was performed for more accurate diagnosis.  All infants with definite CDH or unstable hip was referred to orthopedic clinic. Results: A total number of 6576 newborns were examined over a period of nine months.  Clunk or click was found in 3% (197 neonates).  Only 10 newborns had CDH by clinical and sonographic findings.  Of these, eight had clunk at birth and two had persistent click on repeated examinations.  These were finally diagnosed as CDH. Eleven neonates were born in breech position.  CDH was bilateral in 60% of patients, and solely left-sided in 30 %. The incidence of congenital dislocation of the hip was 1.5/1000.  There was a significant association between the first parity and CDH (p<0.05), but not with maternal age. Conclusion: The incidence of CDH in the sample studied (1.5/1000) is similar to other studies reported so far.  Many of unstable hips showed no abnormality or click on repeated examinations and were thus of no value in diagnosis of CDH.