***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Fifty patients with clinical suspicion of hip dislocation were investigated prospect ively with a dynamic ultrasound stress test . A posterior force was applied to hips in flexion and any movement between the femoral head and the acetabulum was measured . The results of this test showed that posterior movement ranged from 0 to 13.0 mm . Hips that were clinical ly normal had a mean movement of 1.4 mm , hips with minor clinical instability had a mean movement of 0.6 mm , hips with moderate instability had a mean movement of 4.5 mm , and those with major instability had a mean movement of 5.1 mm . This was statistically significant to a 1 % confidence interval . We propose two groups of ultrasound-detected movement : group A < 5.0 mm representing physiologic laxity , and group B ° 5.0 mm being pathological and requiring treatment Objectives The authors report the results of a selective ultrasound screening programme for congenital dislocation of the hip ( CDH ) over a period of 20 years , with the aim of defining the rate of screening , conservative treatment and late presentation requiring surgery . Methods All neonates born from June 1988 to December 2008 ( inclusive ) were included in the prospect i ve cohort , with a minimum follow-up of 12 months . All underwent an early clinical examination of the hips and those with clinical instability were referred for  ultrasound  at 2 weeks ; those with risk factors were sonographically examined at 6 weeks . Risk factors were defined as breech presentation , family history or foot deformity . Results 107 440 live births were clinical ly examined , 20 344 ( 18.9 % ) were referred for ultrasound assessment at either 2 weeks ( due to clinical signs ) or 6 weeks ( due to risk factors ) . 774 ( 3.8 % ) were diagnosed with dysplasia with a crude overall treatment rate of 7.2 per 1000 live births . 37 ( 0.34 per 1000 ) presented late , that is , after 12 weeks of age ; none had detectable clinical signs or risk factors . There were no false negatives . Conclusion Elective screening for developmental dysplasia of the hip in association with one stop treatment and monitoring is an effective programme . The number of infants referred increased statistically significantly year on year over the study period and generated more activity . Pavlik harness treatment rates remained acceptable and steady over the period , despite the increase in referrals . The incidence of late presenting cases ranged from 0 to 4 per year , with no secular trend and there were no ultrasound false negatives OBJECTIVE : We conducted a blinded , r and omized , controlled trial to examine whether mildly dysplastic but stable or instable hips would benefit from early treatment , as compared with watchful waiting . PATIENTS AND METHODS : A total of 128 newborns with mild hip dysplasia ( sonographic inclination angle [ α angle ] of 43 ° –49 ° ) and stable or instable but not dislocatable hips were r and omly assigned  to receive either 6 weeks of abduction treatment ( immediate-treatment group ) or follow-up alone ( active-sonographic-surveillance group ) . The main outcome measurement was the acetabular inclination angle , measured by radiograph , at 1 year of age . RESULTS : Both groups included 64 newborns , and there was no loss to follow-up . With the exception of a small but statistically significant excess of girls in the active-sonographic-surveillance group , there were no statistically significant differences in baseline characteristics between the 2 groups . The mean inclination angle at 12 months was 24.2 ° for both groups ( difference : 0.1 [ 95 % confidence interval ( CI ) : −0.8 to 0.9 ] ) , and all children had improved and were without treatment . The mean α angle was 59.7 ° in the treatment group and 57.1 ° in the active-surveillance group for a difference of 2.6 ° evaluated after 1.5 and 3 months ( 95 % CI : 1.8 to 3.4 ; P < .001 ) . At 1.5 months of age , the hips had improved in all treated children but not in 5 children under active surveillance ( P = .06 ) . Among the sonographic-surveillance group , 47 % received treatment after the initial surveillance period of 1.5 months . CONCLUSIONS : Active-sonographic-surveillance halved the number of children requiring treatment , did not increase the duration of treatment , and yielded similar results at 1-year follow-up . Given a reported prevalence of 1.3 % for mildly dysplastic but stable hips , a strategy of active surveillance would reduce the overall treatment rate by 0.6 % . Our results may have important implication s for families as well as for health care costs Background : Ultrasound is increasingly being used to complement the clinical examination in assessing neonatal hip instability . The clinical examination , although highly sensitive in detecting hip instability , can lead to considerable overtreatment . Purpose : To compare anterior dynamic ultrasound and clinical examination in the assessment of neonatal hip instability and regarding treatment rates . Material and Methods : 536 newborn infants ( out of a population of 18,031 ) were selected , on the basis of a combination of risk factors , clinical signs of hip instability or ambiguous clinical findings , to undergo an anterior dynamic ultrasound examination of the hip , by a method developed by our group . This examination , performed by one out of seven experienced examiners , was compared with the st and ard clinical hip examination conducted by one of four pediatric orthopedic surgeons . The clinical examination was carried out both prior to and within a few hours after the ultrasound examination . Results : The clinical examination diagnosed 81.7 % of the hips as normal , 14.5 % as unstable , and 3.8 % as dislocatable or dislocated . With the dynamic ultrasound method , the corresponding figures were 87.8 % , 10.4 % , and 1.8 % , respectively . Use of the criteria of the clinical examination result ed in treatment of 147 infants . Using the dynamic ultrasound examination as a criterion meant that 87 infants would receive treatment . The calculated treatment rate was 0.85 % when based on the clinical stress test and 0.49 % when based on the dynamic ultrasound . Conclusion : The dynamic ultrasound results reduced the treatment rate by over 40 % when used as a basis for the decision regarding treatment Objective : To evaluate the quality of the routine examination of the newborn as carried out by senior house officers ( SHOs ) and midwives . Design : R and omised controlled trial set in a district general hospital in Southeast Engl and . Eligible babies were  r and omised to a midwife ( 11 ) or an SHO  ( 8) who were then video recorded undertaking the routine newborn examination . Main outcome measures : Quality of 62 observed technical and communication components of the newborn examination , as agreed between independent consultant paediatrician and senior midwife raters . Results : Major differences were found in the rated quality of examinations between midwives and SHOs for the examinations of the heart and lungs , for the overall quality of the examination , and in areas of communication skills . Quality of examination of the hips was assessed as poor for both professional groups . Where there were significant differences between examiners , the quality of the midwives ' examinations was higher . Inter-rater agreement between the consultant paediatricians and senior midwives ranged from excellent to poor for different items of the examination with a mean kappa value of 0.42 across all items indicating moderate agreement . Conclusions : The quality of midwife examinations exceeded that of SHOs . All midwives who examine receive formalised training in the examination of the newborn ; SHOs may benefit from similar specific training . Training for both professional groups may need to be review ed , particularly in relation to agreement on ' gold st and ards ' for the screening of developmental dysplasia of the hip The aim of this study was to evaluate whether universal ( all neonates ) or selective ( neonates belonging to the risk groups ) ultrasound screening of the hips should be recommended at birth . We carried out a prospect i ve , r and omised trial between 1988 and 1992 , including all newborn infants at our hospital . A total of 15 529 infants was r and omised to either clinical screening and ultrasound examination of all hips or clinical screening of all hips and ultrasound examination only of those at risk . The effect of the screening was assessed by the rate of late detection of congenital or developmental hip dysplasia in the two groups . During follow-up of between six and 11 years , only one late-detected hip dysplasia was seen in the universal group , compared with five in the subjective group , representing a rate of 0.13 and 0.65 per 1,000 , respectively . The difference in late detection between the two groups was not statistically significant ( p = 0.22 ) . When clinical screening is of high quality , as in our study , the effect of an additional ultrasound examination , measured as late-presenting hip dysplasia , is marginal . Under such circumstances , we consider that universal ultrasound screening is not necessary , but recommend selective ultrasound screening for neonates with abnormal or suspicious clinical findings and those with risk factors for hip dysplasia BACKGROUND Clinical screening aims to identify and treat neonatal hip instability associated with increased risk of hip displacement , but risks failures of diagnosis and treatment ( abduction splinting ) , iatrogenic effects , and costs to parents and health services . Our objectives were to assess clinical effectiveness and net cost of ultrasonography compared with clinical assessment alone , to provide guidance for management of infants with clinical hip instability . METHODS Infants with clinical hip instability were recruited from 33 centres in UK and Irel and and r and omised to either ultrasonographic hip examination ( n=314 ) or clinical assessment alone ( n=315 ) . The primary outcome was appearance on hip radiographs by 2 years . Secondary outcomes included surgical treatment , abduction splinting , level of mobility , re source use , and costs . Analysis was by intention to treat . FINDINGS Protocol compliance was high , and radiographic information was available for 91 % of children by 12 - 14 months and 85 % by 2 years . By age 2 years , subluxation , dislocation , or acetabular dysplasia were identified by radiography on one or both hips of 21 children in each of the groups ( relative risk 1.00 ; 95 % CI 0.56 - 1.80 ) . Fewer children in the ultrasonography group had abduction splinting in the first 2 years than did those in the no-ultrasonography group ( 0.78 ; 0.65 - 0.94 ; p=0.01 ) . Surgical treatment was required by 21 infants in the ultrasonography group ( 6.7 % ) and 25 ( 7.9 % ) in the no-ultrasonography group ( 0.84 ; 0.48 - 1.47 ) . One child from the ultrasonography group and four from the no-ultrasonography group were not walking by 2 years ( 0.25 ; 0.03 - 2.53 ; p=0.37 ) . Infants in the ultrasonography group incurred significantly higher ultrasound costs over the first 2 years ( pound 42 vs pound 23 , mean difference pound 19 , 95 % CI 11 - 27 ) ; total hospital costs were lower for those infants , but the difference was not significant . INTERPRETATION The use of ultrasonography in infants with screen-detected clinical hip instability allows abduction splinting rates to be reduced , and is not associated with an increase in abnormal hip development , higher rates of surgical treatment by 2 years of age , or significantly higher health-service costs We evaluated risk factors for  neonatal hip instability ( NHI ) at birth using ultrasonography and assessed the reliability of our ultrasound method  by means of an interobserver study . The hips of 4,459 newborns were examined by ultrasound from 1988 to 1990 . The ultrasound evaluation was based mainly on measurement of femoral head coverage ( FHC ) by the bony acetabular roof . The mean FHC was 56 % in boys and 54 % in girls ( a significant difference ) . Fifty-five newborns with unstable hips had a mean FHC of 37 % , which was significantly lower than that of the normal hips . Known risk factors for NHI were confirmed ( breech position , family history of hip dysplasia , increased birth weight ) , but no new risk factors were detected . The interobserver study included 200 hips . The 95 % confidence limit for interobserver variation in FHC ( ±2 SD ) was ±8 % . Because of this moderate interobserver variation , and because the incidence of late-detected hip dysplasia was low ( 0.2 per 1,000 ) , we conclude that our method for ultrasound examination is sufficiently reliable for screening of hips in newborns INTRODUCTION Developmental dysplasia of the hip ( DDH ) can result in chronic pain , gait abnormalities and degenerative arthritis .  Infants with a family history , Breech delivery or unstable/"clicking " of the hip on examination are at higher risk . The goal is to detect cases early enough for normal hip development and function by the end of adolescence , but clinical examination alone is ineffective . MATERIAL S AND METHODS All infants born at the West Middlesex University Hospital , Isle-worth , U.K. , between 3/3/2005 and 21/10/2006 underwent prospect i  ve clinical screening to reveal risk factors of unstable hip on examination , family history of 
    Output:
    
Early  Dynamic Ultrasound ( DUS ) is consistently described as a reliable assessment of NIH .
Conclusions In the context of increased prevalence of DDH in rural Australia , contemporary evidence suggests that introduction of early DUS could provide rural infants with more effective screening than clinical examination alone .
Targeted early advice about posturing and simple removable supports to abduct infant hips could prevent some cases of DDH in rural Australia