LATE DIAGNOSIS OF CONGENITAL DISLOCATION OF THE HIP AND MEDICAL MALPRACTICE LAWSUITS

Despite the screening campaigns for early detection of congenital dislocation of the hip, some cases continue to be diagnosed late. The main reason for the failure to diagnose this disorder at an early stage is still unclear. A dislocated or a dislocatable hip is not always apparent during the initial newborn screening examination, and repeated clinical examinations throughout the first 12 months are necessary in order to establish the Presence or absence of this disorder. At birth, radiographs are usually normal and a systematic pelvic radiograph of the neonate has no place in neonatal screening. Sonography helps to detect hip pathology early. However owing to the dynamic nature of the disorder, a single early non-selective ultrasound has proved to be too sensitive and to lack specificity. In the United States, failure to diagnose the congenital dislocation of the hip is the most common musculoskeletal cause of litigation brought against pediatricians. In Europe, the system of fault liability implicates an obligation of ability and means. Failure to diagnose or misdiagnosis is not a fault in itself as long as a complete history, careful physical examination and adequate and appropriate complementary examinations nations have been performed by an adequately trained physician. If congenital hip dislocation is recognized and treated early, most of the affected children will develop functionally and radiologically normal hips. The longer the dislocation remains untreated, the harder it is to relocate the hip and the higher the incidence of secondary acetabular dysplasia, necessitating surgical correction. However, early treatment is not always successful or without complication. Consequently, the damages due to late onset of the treatment are difficult to assess. Although there are no certainties as to the outcome of any particular malpractice suit, it seems to the authors that the cases in which failure to diagnose a congenital dislocation of the hip should lead to reparation of a damage due to a fault, are extremely rare.