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Håberg Ø, Foss OA, Gundersen T, Bjerkestrand Lian Ø, Slettvåg Hoel M, Holen KJ. The incidence of late-detected developmental dysplasia of the hip and its functional outcomes: a 17-year cohort study using selective ultrasound screening. Acta Orthop 2023; 94:588-593. [PMID: 38084932 PMCID: PMC10714967 DOI: 10.2340/17453674.2023.24578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND PURPOSE We aimed to establish the incidence of late-detected developmental dysplasia of the hip (DDH) with a selective ultrasound (US) examination over 17 years using the femoral head coverage (FHC) as a US measurement. The secondary aim was to establish the everyday function using patient-reported outcome measures (PROMs). PATIENTS AND METHODS The incidence of late-detected DDH was based on 60,844 children. Patients diagnosed for the first time after 3 months and before the age of 8 years were included. In the second part of the study, consent to participate was mandatory. PROMIS-25 Pediatric, PROMIS-25 Parent, and EQ-5D-5L were used according to the patient's age to assess everyday function. RESULTS The incidence of late-detected DDH was 0.48/1,000. The median age at diagnosis was 8 months (range 4-41 months), with a tendency to require repeated treatment with open surgery if DDH was diagnosed later. Most children reported no or minor health problems with a mean of 18 years' follow-up. CONCLUSION We found that selective US examination of the hips by measuring the FHC is a reliable method to examine newborns for DDH resulting in a low incidence of late-detected DDH amounting to 0.48/1,000 newborn children.
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Affiliation(s)
- Øyvind Håberg
- Department of Orthopedic Surgery, Kristiansund Hospital; Institute of Neuro Medicine and Movement Science, NTNU, Trondheim.
| | - Olav Andreas Foss
- Department of Orthopedic Surgery, Trondheim University Hospital; Institute of Neuro Medicine and Movement Science, NTNU, Trondheim
| | - Trude Gundersen
- Department of Orthopedic Surgery, Haukeland University Hospital, Norway
| | - Øystein Bjerkestrand Lian
- Department of Orthopedic Surgery, Kristiansund Hospital; Institute of Neuro Medicine and Movement Science, NTNU, Trondheim
| | | | - Ketil J Holen
- Department of Orthopedic Surgery, Trondheim University Hospital; Institute of Neuro Medicine and Movement Science, NTNU, Trondheim
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Clinical Examination Findings Can Accurately Diagnose Developmental Dysplasia of The Hip-A Large, Single-Center Cohort. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020304. [PMID: 36832433 PMCID: PMC9954844 DOI: 10.3390/children10020304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Physical examination findings such as limited hip abduction (LHA), asymmetric skin creases (ASC), and a popping sensation in the hip facilitate the diagnosis of developmental dysplasia of the hip (DDH). Screening with a simple physical examination during the first weeks of infancy is important for early detection of the condition, and a wide range of medical professionals, including general practitioners, obstetricians, pediatricians, and orthopedic surgeons etc. are involved in this process. The aim of this study was to determine the correlation between easily recognizable physical examination findings such as LHA, thigh/groin ACSs, and Ortolani and Barlow tests with ultrasound findings for the diagnosis of DDH. METHODS This study included 968 patients undergoing routine hip ultrasonography between December 2012 and January 2015. All patients were examined by an experienced orthopedic surgeon who was not the physician who performed the ultrasound examination to exclude bias between physical examination findings and ultrasound findings. Asymmetric skin folds (thigh and groin), limited abduction, Barlow and Ortolani tests were recorded. The relationship between the physical examination findings, ultrasound findings, and developmental dysplasia was investigated. RESULTS Of the 968 patients, 523 were female (54%) and 445 were male. On ultrasonography examination, 117 patients were found to have DDH. The sensitivity, specificity and negative predictive values of patients who were found to have both LHA and thigh/groin ASCs in all three physical examinations were high (83.8%, 70.2%, and 96.9%, respectively) while positive predictive values were found to be low (27.8%). CONCLUSION Asymmetric skin creases on the thigh and groin and limited hip abduction, when evaluated together, have high sensitivity and specificity with additional high negative predictive values and could help during the initial screening process of DDH.
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Cheok T, Smith T, Wills K, Jennings MP, Rawat J, Foster B. Universal screening may reduce the incidence of late diagnosis of developmental dysplasia of the hip : a systematic review and meta-analysis. Bone Joint J 2023; 105-B:198-208. [PMID: 36722053 DOI: 10.1302/0301-620x.105b2.bjj-2022-0896.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS We investigated the prevalence of late developmental dysplasia of the hip (DDH), abduction bracing treatment, and surgical procedures performed following the implementation of universal ultrasound screening versus selective ultrasound screening programmes. METHODS A systematic search of PubMed, Embase, The Cochrane Library, OrthoSearch, and Web of Science from the date of inception of each database until 27 March 2022 was performed. The primary outcome of interest was the prevalence of late detection of DDH, diagnosed after three months. Secondary outcomes of interest were the prevalence of abduction bracing treatment and surgical procedures performed in childhood for dysplasia. Only studies describing the primary outcome of interest were included. RESULTS A total of 31 studies were identified, of which 13 described universal screening and 20 described selective screening. Two studies described both. The prevalence of late DDH was 0.10 per 1,000 live births (95% confidence interval (CI) 0.00 to 0.39) in the universal screening group and 0.45 per 1,000 live births (95% CI 0.31 to 0.61) in the selective screening group. Abduction bracing treatment was performed on 55.54 per 1,000 live births (95% CI 24.46 to 98.15) in the universal screening group versus 0.48 per 1,000 live births (95% CI 0.07 to 1.13) in the selective screening group. Both the universal and selective screening groups had a similar prevalence of surgical procedures in childhood for dysplasia being performed (0.48 (95% CI 0.32 to 0.63) vs 0.49 (95% CI 0.31 to 0.71) per 1,000 live births, respectively). CONCLUSION Universal screening showed a trend towards lower prevalence of late DDH compared to selective screening. However, it was also associated with a significant increase in the prevalence of abduction bracing without a significant reduction in the prevalence of surgical procedures in childhood for dysplasia being performed. High-quality studies comparing both treatment methods are required, in addition to studies into the natural history of missed DDH.Cite this article: Bone Joint J 2023;105-B(2):198-208.
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Affiliation(s)
- Tim Cheok
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Australia.,Department of Orthopaedic Surgery, Palmerston North Hospital, Palmerston North, New Zealand
| | - Thomas Smith
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Kenneth Wills
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Matthew P Jennings
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Australia
| | - Jaideep Rawat
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Australia.,Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia.,Department of Orthopaedic Surgery, Women's and Children's Hospital, Adelaide, Australia
| | - Bruce Foster
- Department of Trauma and Orthopaedics, Alice Springs Hospital, Alice Springs, Australia.,Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
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Kanakamedala AC, Jejurikar NS, Castañeda P. Hip morphology on initial ultrasound predicts hip morphology at one year in developmental dysplasia of the hip. J Child Orthop 2022; 17:79-85. [PMID: 37034190 PMCID: PMC10080245 DOI: 10.1177/18632521221141085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose: This study aimed to determine whether point-of-care ultrasound performed during the Pavlik method treatment of developmental dysplasia of the hip predicts acetabular morphology at 12 months of age. Methods: We reviewed the medical records, ultrasounds, and radiographs of patients treated successfully with the Pavlik method between 2017 and 2019. We performed sonographic measurements on point-of-care ultrasound at the initial presentation, the Pavlik discontinuation, and an additional sonographic follow-up. We measured the acetabular index on a plain anteroposterior radiograph of the pelvis obtained at a minimum of 12 months of age. Spearman’s rank correlation coefficient was used to analyze for correlation between sonographic measurements and the acetabular index. Results: A total of 72 patients were included in the final analysis. There were no residual or late dysplasia cases at the last radiographic follow-up (mean age = 14.8 ± 2.7 months). Sonographic parameters at the initial presentation significantly correlated with the acetabular index at the final radiographic follow-up (p < 0.001). Patients with worsening degrees of developmental dysplasia of the hip based on stability on sonographic testing (stable, unstable, or dislocated) had higher acetabular indices at the final radiographic follow-up (p < 0.05). Conclusion: Point-of-care ultrasound at initial presentation and the Pavlik discontinuation significantly correlate with acetabular morphology at 1–1.5 years of age. At initial presentation, hips that were unstable or dislocated on point-of-care ultrasound had significantly greater acetabular indices than stable hips at the final follow-up. Level of evidence: level IV case series.
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Affiliation(s)
| | | | - Pablo Castañeda
- Pablo Castañeda, Department of Orthopedic
Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E. 17th
Street, Office 400B, New York, NY 10003, USA.
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de Borja C, Watkins R, Woolridge T. Common Ultrasound Applications for Pediatric Musculoskeletal Conditions. Curr Rev Musculoskelet Med 2022; 15:447-455. [PMID: 35932426 PMCID: PMC9789252 DOI: 10.1007/s12178-022-09788-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To discuss the use of ultrasound for diagnosis and management of common pediatric musculoskeletal conditions through a case-based approach. RECENT FINDINGS Ultrasound is an essential diagnostic modality in the early detection of developmental dysplasia of the hips and can be used as early as 6 weeks of age when the ossific nucleus has not developed yet. Ultrasound is helpful in diagnosing traumatic injuries such as fractures and intramuscular hematomas, can visualize fracture healing at early stages, and can also be used to guide aspiration of hematomas that can help with decreasing pain and faster recovery. Ultrasound is superior to radiographs in evaluating joint effusions and soft tissue infections or masses and is better tolerated by children compared to other imaging modalities such as magnetic resonance imaging (MRI). Ultrasound is an easily accessible, affordable, non-invasive, and radiation-free imaging modality that is well tolerated by children and their families. It can aid in the diagnosis and management of a wide variety of musculoskeletal conditions including developmental, traumatic, and infectious etiologies, as well as in the evaluation of superficial soft tissue masses.
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Affiliation(s)
- Celina de Borja
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, University of California, San Francisco, 1825 4th Street – 5th Floor, San Francisco, CA 94158 USA
| | - Rhonda Watkins
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, University of California, San Francisco, 1825 4th Street – 5th Floor, San Francisco, CA 94158 USA
| | - Tiana Woolridge
- Department of Pediatrics, University of California, San Francisco, San Francisco, USA
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Håberg Ø, Bremnes T, Foss OA, Angenete O, Lian ØB, Holen KJ. Children treated for developmental dysplasia of the hip at birth and with normal acetabular index at 1 year: How many had residual dysplasia at 5 years? J Child Orthop 2022; 16:183-190. [PMID: 35800653 PMCID: PMC9254022 DOI: 10.1177/18632521221106376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/28/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of the study was to assess the effect of further follow-up for children treated for developmental dysplasia of the hip, with normal clinical and radiological findings at 1-year time point. The effect was quantified by the number of hips with a pathologic deterioration up to 5 years. METHODS Among 47,289 children born in Sør-Trøndelag county in Norway between 2003 and 2015, 265 children had developmental dysplasia of the hip. Of these, 164 children (239 hips) treated for developmental dysplasia of the hip with normal clinical findings and normal acetabular index at the 1-year time point were included in the study. The number of hips with pathologic acetabular index at the 5-year time point were reported. The diagnostic uncertainty related to radiological measurements was quantified together with the effect of introducing a second radiographic measurement, the center edge angle. RESULTS A total of 239 treated hips were normal at the 1-year time point. At 5-year time point, 10 (4.2%) hips had a pathologic acetabular index measurement and none classified to have developmental dysplasia of the hip caused by measurement inaccuracy. Eight (3.3%) hips had pathologic center edge angle measurement. Four hips had both pathologic acetabular index and center edge angle measurements, with three later treated with surgery. The intra- and interobserver repeatability coefficients were within 3.1°-6.6°. CONCLUSION The repeatability coefficient of the acetabular index measurements was high and no hips could be classified to have developmental dysplasia of the hip at the 5-year time point when taking this repeatability into account. Hips classified as pathologic combining acetabular index and center edge angle measurements were likely to be treated with surgery for residual dysplasia. We recommend further follow-up for these children. LEVEL OF EVIDENCE level II.
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Affiliation(s)
- Øyvind Håberg
- Department of Orthopedic Surgery,
Kristiansund Hospital, Kristiansund, Norway,Institute of Neuromedicine and Movement
Science, Faculty of Medicine and Health Services, NTNU, Trondheim, Norway,Øyvind Håberg, Department of Orthopedic
Surgery, Kristiansund Hospital, Herman Døhlens vei 1, N-6508 Kristiansund,
Norway.
| | - Thomas Bremnes
- Department of Radiology and Nuclear
Medicine, St. Olav’s Hospital, Trondheim University Hospital, Trondheim,
Norway
| | - Olav A Foss
- Institute of Neuromedicine and Movement
Science, Faculty of Medicine and Health Services, NTNU, Trondheim, Norway,Department of Orthopedic Surgery,
Trondheim University Hospital, Trondheim, Norway
| | - Oskar Angenete
- Department of Radiology and Nuclear
Medicine, St. Olav’s Hospital, Trondheim University Hospital, Trondheim,
Norway,Institute of Circulation and Medical
Imaging, Faculty of Medicine and Health Services, NTNU, Trondheim, Norway
| | - Øystein B Lian
- Department of Orthopedic Surgery,
Kristiansund Hospital, Kristiansund, Norway,Institute of Neuromedicine and Movement
Science, Faculty of Medicine and Health Services, NTNU, Trondheim, Norway
| | - Ketil J Holen
- Institute of Neuromedicine and Movement
Science, Faculty of Medicine and Health Services, NTNU, Trondheim, Norway,Department of Orthopedic Surgery,
Trondheim University Hospital, Trondheim, Norway
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Koşar PN, Ergün E, Gökharman D. Can Medialization of Acetabular Rim Be a Prognostic Factor in Treatment of Developmental Dysplasia of Hip? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:645-652. [PMID: 34008885 DOI: 10.1002/jum.15745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate if acetabular rim medialization (ARM) can be used as a new parameter in determining the treatment choice and duration in Graf type III and IV hips. METHODS Among the 12,300 infants who underwent hip ultrasound (US) according to Graf's method between 2015 and 2019, 26 infants (9 had bilateral pathology hence 35 hips) with type III and IV hips, whose follow-up data could be obtained were included in the study. Age of the infants at the initial diagnosis, ARM measurement, the duration of harness treatment, and the treatment results were noted. To determine the extent of ARM, distance between a line that is drawn tangential to the iliac wing and acetabular rim was measured. RESULTS In cases with poor prognosis, ARM measurement was 6 to 8.5 mm on the right hip and 4 to 9 mm on the left hip. Bilaterality or unilaterality, left or right pathology, and gender did not have a significant effect on the prognosis (P >.05). Age at the initial diagnosis and ARM had significant effects on treatment success (P = .04, P = .00, respectively). In predicting the prognosis, ARM was found to be more successful than age (AUC = 0.95 versus AUC = 0.68). When these two variables were evaluated together, the success in predicting the prognosis significantly increased (AUC = 0.98). CONCLUSIONS ARM measurement may have an important role in determining the treatment method and duration in Graf type III and IV hips. It can be used as a prognostic factor alone or in combination with treatment initiation time. When the two factors are combined, prognostic value significantly increases.
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Affiliation(s)
- Pınar Nercis Koşar
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Elif Ergün
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Dilek Gökharman
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
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Fludder CJ, Keil BG, Neave MJ. Case report: Morphological changes evident after manual therapy in two cases of late-diagnosed developmental dysplasia of the hip. Front Pediatr 2022; 10:1045812. [PMID: 36776679 PMCID: PMC9909744 DOI: 10.3389/fped.2022.1045812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/28/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Late diagnosed Developmental Dysplasia of the Hip (DDH) is the detection of DDH after 3 months of age and is associated with significantly poorer outcomes than when diagnosed and managed early. Late diagnosed DDH has lower rates of success with bracing, higher rates of surgery and higher rates of complications, including avascular necrosis of the femoral head and early osteoarthritis of the hip. We describe two cases of late-diagnosed DDH which demonstrated changes in femoroacetabular joint morphology on radiographic interpretation after a 6-month trial period of manual therapy. CASE PRESENTATION Two cases (13 and 30 months of age) with late-diagnosed DDH presented to a private chiropractic clinic for conservative, non-bracing management. One case had unilateral DDH and the other bilateral DDH. A trial of manual therapy was utilized over a 6-month period. Both cases demonstrated changes to femoroacetabular morphology as well as improvements in gross motor activity and lower extremity muscle tone. CONCLUSION Manual therapy, as an adjunct or alternative to static bracing, may be of benefit in individuals with late-diagnosed DDH not responding to bracing, and prior to more invasive interventions. Additional cases of manual therapy-based management of this condition are required to inform the design of future trials to investigate this hypothesis.
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The Association of Asymmetric Skinfolds and the Diagnosis of Developmental Dysplasia of the Hip in Infants. Adv Neonatal Care 2021; 22:352-356. [PMID: 34387217 DOI: 10.1097/anc.0000000000000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The clinical finding of asymmetric skinfolds (ASF) in infants is used to indicate the possibility of developmental dysplasia of the hip (DDH). The association of ASF and a diagnosis of DDH remains unknown. PURPOSE To determine the association of ASF in the gluteal and femoral regions with a diagnosis of DDH. METHODS The correlation of ASF and other physical examination findings with DDH was compared retrospectively. The medical records of infants who underwent DDH screening in the clinic were analyzed. The physical examination findings were reviewed and categorized as ASF, clunk of the hip, limb-length discrepancy, hip abduction limitation, combined conditions of musculoskeletal disorders, and regular screening for DDH. The hip conditions were classified by Graf's ultrasound method. Type IIb and higher classifications were defined as DDH. The diagnosed rate and severity of DDH based on physical examination findings were calculated and compared. RESULTS Clinical data of 3266 infants aged up to 6 months were reviewed, and 194 infants were diagnosed with DDH by ultrasound examination. ASF was the most common indication for DDH screening (64.5%; 2107/3266). However, this was poorly correlated with a diagnosis of DDH (4.79%; P < .0001). No difference was found between the Graf classification severity and various indications (P = .079). IMPLICATIONS FOR PRACTICE Clinicians should recognize that, although ASF is the most common reason for DDH screening in infants, ASF does not correlate with a diagnosis of DDH. IMPLICATIONS FOR RESEARCH Additional research should examine the relationship between DDH and ASF in other populations.
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Lussier EC, Lei WT, Sun YT, Chen HW, Chang TY, Chang CH. Newborn Hip Screenings at 4 to 8 Weeks Are Optimal in Predicting Referral and Treatment Outcomes: A Retrospective Review. ACTA ACUST UNITED AC 2020. [DOI: 10.4236/ojped.2020.102034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Na XMD, Bei XMD, Hongwei TMD, Ke SMD, Qinghua LMD, Wenjuan CMD, Dan WMD, Hong GMD, Yan GMD, Yan LMD, Jun GMD, Jianbo TMD. Chinese Expert Consensus on Ultrasonographic Acquisition, Measurement, and Reporting System for Developmental Dysplasia of the Hip. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.190041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Tan SHS, Wong KL, Lim AKS, Hui JH. The earliest timing of ultrasound in screening for developmental dysplasia of the hips. Ultrasonography 2019; 38:321-326. [PMID: 31117162 PMCID: PMC6769192 DOI: 10.14366/usg.18075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/03/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose The current study aimed to evaluate the results of ultrasound screening for developmental dysplasia of the hips (DDH) done at various weeks of life, to determine the earliest time that ultrasound screening can be performed reliably. Methods In this 17-year cohort study, all neonates who underwent ultrasound screening prior to the 12th week of life with subsequent follow-up radiography done at 1 year of life were included. The ultrasound images were evaluated according to the Graf classification, Harcke’s dynamic ultrasound screening method, and Terjesen’s femoral head coverage method. The radiographic images were evaluated according to the acetabular index and the femoral head position. The accuracy and correlation between the ultrasound findings from various weeks of life with the radiographic findings at 1 year of life were evaluated. Results A total of 348 neonates were included in the study, of whom 92 had abnormal ultrasound findings and 42 had abnormal radiographic findings at 1 year. Significant differences were identified between the findings of ultrasound screening examinations performed prior to the fourth week of life (day 21 and before) and the radiographic findings at 1 year of life (P<0.05). In contrast, no significant differences were identified when ultrasound screening was performed between the fourth and 12th weeks of life (day 22 and beyond) (P>0.05). The accuracy of ultrasound screening was 79.2% or higher when performed during or after the fourth week of life (day 22 and beyond). Conclusion The earliest that ultrasound screening for DDH can be performed reliably is during the fourth week of life (day 22 and beyond).
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Affiliation(s)
- Si Heng Sharon Tan
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System (NUHS), Singapore
| | - Keng Lin Wong
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System (NUHS), Singapore
| | - Andrew Kean Seng Lim
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System (NUHS), Singapore
| | - James Hoipo Hui
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System (NUHS), Singapore
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