Do infants born with an isolated clubfoot (talipes equinovarus) require radiological investigations to rule out congenital hip dysplasia?
You are a neonatal SHO. The midwife asks you to see a term baby who has just been born. She has noticed the baby to have a clubfoot and wants you to examine the baby.Physical examination confirms a clubfoot and there are no other abnormalities. Both hips are stable on clinical examination using the Ortolani and Barlow’s test.

Your registrar asks you to request a hip ultrasound or hip X-ray for this baby to rule out DDH. You are not used to this practice and decide to appraise the evidence behind it.

Drs Pickerd and Adappa at the Neonatal Unit, Royal Gwent Hospital have submitted this question, and it’s not one I’d ever considered. Archi has previously looked at the associations of ear pits and renal abnormalities, but has been too worried by the chisels of orthopedicians to stray across their paths.

The question interests us as it has elements of frequency (is it common enough to bother about), cost (to child, parents and radiology – time, worry and £££) and benefit (are you better off knowing?).

To paraphrase Dr Seuss, “What WOULD you do, if your Registrar asked you?”

Acknowledgements: Image: richardmasoner from Flickr under the creativecommons2.0 licence. Mis-quotation: Cat in the Hat, Dr Seuss. (Random House Books for Young Readers, 1957)