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Scientific Articles   |    
Does Swaddling Influence Developmental Dysplasia of the Hip?An Experimental Study of the Traditional Straight-Leg Swaddling Model in Neonatal Rats
Enbo Wang, MD, PhD1; Tianjing Liu, MD1; Jianjun Li, MD, PhD1; Eric W. Edmonds, MD2; Qun Zhao, MD, PhD1; Lijun Zhang, MD1; Xiaoming Zhao, MD1; Kang Wang, MD1
1 Department of Pediatric Orthopaedics, Shengjing Hospital, China Medical University, Shenyang, 110004, China. E-mail address for Q. Zhao: wangenbodor@gmail.com
2 Department of Orthopaedics, Rady Children's Hospital, 3030 Children's Way, Suite 410, San Diego, CA 92123
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

  • Disclosure statement for author(s): PDF

Department of Pediatric Orthopaedics, Shengjing Hospital, China Medical University, Shenyang, 110004, China. E-mail address for Q. Zhao: wangenbodor@gmail.com
Department of Orthopaedics, Rady Children's Hospital, 3030 Children's Way, Suite 410, San Diego, CA 92123
Investigation performed at Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
This article was chosen to appear electronically on May 9, 2012, in advance of publication in a regularly scheduled issue.
A commentary by Charles T. Price, MD, is linked to the online version of this article at jbjs.org.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jun 20;94(12):1071-1077. doi: 10.2106/JBJS.K.00720
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Abstract

Background: 

The overall effect of swaddling has been controversial for centuries. Its positive effect on the psychological development of the infant has popularized it in European and North American countries, but its negative effect on the development of the hip is of great concern. In our experiment, the influence of straight-leg swaddling in an animal model was observed radiographically and histologically.

Methods: 

One hundred and twelve neonatal rats were divided into a control group and three experimental groups that were swaddled with use of surgical tape in a manner simulating the human practice for the first five days of life (early swaddling), the second five days (late swaddling), and the first ten days (prolonged swaddling). Hip dislocation and subluxation were evaluated on anteroposterior pelvic radiographs, and histological studies were performed to further observe the morphology of the hips.

Results: 

Rats in the prolonged swaddling group had the highest prevalence of hip dysplasia (thirty-six of forty-four), followed by the early swaddling group (twenty-one of forty-four). Most of the dysplastic hips in the prolonged swaddling group were dislocated, whereas subluxation dominated in the late swaddling group. Differences between the sexes were significant only in the early swaddling group, and differences between sides were not significant in any group. Appositional growth of the acetabular cartilage and deformity of the triradiate cartilage complex were observed in the dislocated and subluxated hips.

Conclusions: 

Straight-leg swaddling was demonstrated to increase the prevalence of developmental dysplasia of the hip in this animal model, especially if the swaddling was early or prolonged. The severity of hip impairment varied, with early and prolonged swaddling both leading to more dislocations than subluxations. Sex differences also existed but a side preference was not observed. Appositional growth of acetabular cartilage and a deformed triradiate cartilage complex were the pathological basis of the hip dysplasia in this animal model.

Clinical Relevance: 

Traditional swaddling in human infants should be avoided to allow normal hip development; more modern alternatives that do less harm to hip development in human infants are available.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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