Managing the persistent vegetative state.

more complicated situation than is suggested. Hip sonography was introduced in Austria in 1980 and has been painstakingly followed up since then.2 The results of examinations of many tens of thousands of neonatal hips are now available. From the beginning immediate vigorous conservative treatment was instituted for all dysplastic and unstable hips. This was followed by an extensive and eventually comprehensive ultrasound screening programme for all newborn infants in the maternity unit.' This policy resulted in a dramatic reduction in the average age at diagnosis of hip dysplasia4itself a strong prognosticator of improved outcome. Over the ensuing years the numbers of babies presenting with late dislocation of the hip and with hips failing to mature completely fell to almost zero. Practically all children have now finished their treatment before the age at which they start to walk. Operative reduction has not been necessary in the screened group for several years, and congenital dislocation of the hip has been completely eradicated among Austrian babies (R Graf, personal communication). The savings due to the reduction of the number of operations more than cover the cost of the entire screening programme. Thus the large long term trial that Clarke calls for was completed and reported on several years ago. Its results are staggering if true because they imply that many hundreds of children are still suffering from a crippling but completely preventable disease. Such results may need to be corroborated and confirmed, but at the very least the enormous Austrian and German experience needs to be taken into account.