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The condition now termed developmental dysplasia of the hip (DDH, previously congenital dislocation of the hip) has been prevalent since prehistoric times: paleopathologists have identified it in ancient skeletons.1 The earliest written accounts are attributed to Hippocrates (460–370 BCE), and showed remarkable insight into intrauterine compression deformity:
When in the womb there is a narrowness at the part where in fact the crippling is produced….It is thus that trees which…have not enough space, and are hindered by a stone or other thing, become bent during growth.2
He presciently recommended early treatment with ‘continued application of gentle pressure’.
Two thousand years later, French surgeon Ambroise Paré in 1575 again recognised that deformation during pregnancy might be a cause, advising women against the wearing of tight garments.3 It was not until 1826, when another French surgeon Baron Guillaume Dupuytren, famed both for the eponymous contracture and as Napoleon’s personal surgeon, wrote the first definitive account.4 Describing its intrauterine mechanical origins, he explained how the flexed position of the fetal femur could result in dislocation if ‘such joint is weak or of lax, unresisting fibre’. Importantly, he stressed the importance of recognition soon after birth.
Fifty years later, German surgeon Wilhelm Roser recognised the contribution of compression due to oligohydramnios.5 He advocated looking for ‘children whose flail hips could be dislocated by adduction of the leg and then reduced again by abduction’, and claimed that hips ‘could be restored to normal if the condition was discovered neonatally and immediately treated with an abduction splint’. His ideas were not accepted at the time.
In 1912, French surgeon Pierre Le Damany studied the anatomy of …
Contributors PMD carried out the historical research and wrote the original long paper. RS-J adapted and shortened the long paper, and added some material.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Author note Sadly, the first author Professor Peter Dunn died aged 92 years on 2 February 2021, just after this article had been provisionally accepted. His contributions to the science and practice of neonatology, and latterly to the history of paediatrics, were immense.
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