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(1) Clinical examination of the hips should be systematically performed in the newborn, in order to detect a possible congenital dislocation. This translates into hip joint instability, which can be evidenced by both Ortolani's and Barlow's signs, the latter being more sensitive. Special attention should be paid for abduction range, as limited abduction is a warning sign. (2) Use of imaging, especially sonography will be restricted to specific cases only. It's prescription, technical realization as well as interpretation have to be carefully done, so that it is actually relevant to uncertain or "at risk" situations. (3) Treatment if needed, should be ideally managed by a paediatric orthopaedic surgeon.

We studied the value of ultrasound examination combined with conventional clinical evaluation in screening for congenital defects of the hip in a study including more than 3,000 neonates. We used two kinds of ultrasound methods, i.e. the morphological method, that is highly standardized and seeks to identify several well-defined anatomic landmarks (Graf's technique), and the dynamic method, that uses transverse flexion, frontal flexion or medial sections to determine the degree of stability of the hip. We describe these sections in detail so that pediatricians may correctly appreciate the images obtained. The respective indications of each section depend on the findings made as the investigation advances. Rigorous adherence to precise rules is now possible and is the only means for ensuring that these techniques will be used rationally in a way that can be expected to significantly reduce the still considerable number of dislocations and dysplasias of the hip discovered beyond three months of age.

Between 1975 and 1987, 83 Chiari osteotomies were performed on 49 women and 11 men. The osteotomy was bilateral in 5 cases. The average age was 34 years. The average follow-up was 4 years with a range of 1 to 12 years. In 65 patients there was acetabular dysplasia, associated in 26 cases with coxa valga and, in one patient, with coxa vara. In 12 cases there was a subluxation of the femoral head, greater than 15 mm and in 16 cases, the femoral head was deformed after a post-reductional osteochondritis. The technique and results are discussed.

140 hips of fetuses have been studied using the Graf technique for morphological descriptions, the Harcke technique for dynamic studies. Then the hips were transected following the same plane as for sonography. The authors established that there was a significant relation between the progressive dysplasia of the acetabular roof and the sonographic morphological studies. The relation with the dynamic studies was less marked on cadavers studied shortly after delivery. The authors concluded that hyperpressure on the femoral head during the three last months of the pregnancy seems to be an important causal factor.

The authors have had the opportunity of making a complete and precise dissection of newborns with congenital dislocation of the hip. They have also made a dynamic study of the hip joints in the specimens. The findings have been compared with other studies published in the literature. It is concluded that the dislocation is posterior or postero-superior and that acetabular dysplasia is consistent in unstable hips in the newborn. The acetabular plasia is secondary to the dislocation and lies postero-superiorly. It cannot be detected radiologically. The existence of primary acetabular dysplasia is doubtful. The main responsibility for congenital dislocation of the hip is a faulty position of the foetus in utero. The disease therefore cannot be prevented. It is of importance to diagnose the disease as soon as possible.