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Cast life: A Parent's Guide to DDH: Developmental Dysplasia of the Hip Explained

Natalie Trice. pp.218 Nell James Publishers, 2015. ISBN-13: 978-1910923016

The book starts off with the author's emotional trauma and long-term anxieties about her son who is now six, but was born with a dislocated hip.There follows a raft of conscientiously assembled practical information about how to cope with a youngster in a hip spica. She robustly and correctly advises parents to make the best of their lot, not to be angry, and to channel their energy into their baby, family, marriage and so on - very good and very positive.There is a whole chapter at the end devoted to useful web links for parents who find themselves in a similar predicament. We discover that her baby boy (second-born) was born uneventfully. The right hip was recorded as clicky and there was a strong family history of DDH with a maternal aunt and a first cousin both affected. A scan appointment was promised before discharge but never materialised.There were parental concerns about skin creases and shortening evident to the parental eye. He was eventually scanned at about four months, and the hip was completely dislocated.

The next day an orthopaedic surgeon applied a Pavlik harness and indicated that it would be needed for four to five months.

The mother searched online and (luckily) discovered that the Pavlik was ineffective treatment at this age, and went to another orthopaedic surgeon, who reported Tönnis grade 3 acetabular dysplasia.

There followed an unhappy saga of  closed reduction at six months, failed resolution of acetabular dysplasia, another closed reduction, followed by a further stretch in plaster, an open reduction and femoral osteotomy (more plaster!) and metalwork removal, and leg length discrepancy. The boy is not six years old and planned for pelvic osteotomy. There then follows an embarrassingly long chapter of largely disappointing parent stories. These consist of multiple ineffective treatments on similarly delayed diagnosed and treated babies, with similarly disappointing outcomes.  

By the end, I wondered if information given to parents, expectations of treatment and indeed better appraisal of the underlying pathology and its treatment could not be very much improved. 

Reviewed by Mr John O’Hara