Infantile skeletal skew: the use of ultrasound in management

The term 'infantile skeletal skew' recognizes the prenatal or postnatal moulding of a small proportion of babies who develop characteristic changes including plagiocephaly, wry neck, scoliosis, pelvic obliquity and postural foot deformities. Pelvic obliquity may cause an abduction contracture of the hip on one side and an adduction contracture on the other, and radiographs may suggest a 'dysplasia' of the acetabulum on the adducted side, giving rise to concern that the hip is unstable. In these cases we have found that early ultrasound assessment of the adducted side will reassure the clinician that the hip is 'in joint' and the condition should be allowed to resolve itself over several months without any treatment. Eighteen infants with features of moulding in whom there was concern over the development of the hip on the adducted side, have been prospectively studied with the use of ultrasound until the age of 18 months when a final radiograph confirmed normal development of the hips.