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Stavinoha TJ, Pun SY, McGlothlin JD, Uzosike MB, Segovia NA, Imrie MN. No Delay in Age of Crawling, Standing or Walking with Pavlik Harness Treatment: A Prospective Cohort Study. J Am Acad Orthop Surg 2024; 32:390-395. [PMID: 37862341 DOI: 10.5435/jaaos-d-21-00249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/15/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Pavlik harness treatment is the standard of care for developmental dysplasia of the hip in infants younger than 6 months. The effect of Pavlik harness treatment on the achievement of motor milestones has not previously been reported. METHODS In this prospective cohort study, 35 patients were prospectively enrolled to participate and received questionnaires with sequential clinical visits monitoring treatment of their developmental dysplasia of the hip. One-sample Student t -tests assessed differences in milestone attainment age, and the Benjamini-Hochberg procedure was conducted to decrease the false discovery rate. Post hoc power analyses of each test were conducted. The age of achievement of eight early motor milestones were recorded and compared with a previously published cohort of healthy infants. RESULTS Infants treated with a Pavlik harness achieved four early motor milestones markedly later than the reported age of achievement in a historical control group. These milestones included "roll supine" (5.3 vs. 4.5 months; P = 0.039), "roll prone" (5.7 vs. 5.0 months; P = 0.039), "sit" (6.4 vs. 5.2 months; P < 0.001), and "crawl on stomach" (7.7 vs. 6.6 months; P = 0.039). However, there was no difference in time to achievement of later motor milestones of "crawl on knees," "pull to stand," and "independent walking." CONCLUSION Several early motor milestones were achieved at a statistically significantly later time than historical control subjects not treated in a Pavlik harness. Despite statistical significance, the small delays in early motor milestones were not thought to be clinically significant. No differences were observed in the later motor milestones, including knee crawling, standing, and independent walking. Clinicians and parents may be reassured by these findings. LEVEL OF EVIDENCE Therapeutic Level II-prospective study.
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Affiliation(s)
- Tyler J Stavinoha
- From the Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Lucile Packard Children's Hospital at Stanford, Stanford, CA
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2
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Volkan Çetin B, Bakırcıoğlu S, Çiftci S, Salih Söylemez M, Erkuş S, Turhan Y, Yalkın Çamurcu İ, Duman S, Yıldırım T, Memişoğlu K, Şenaran H, Ömeroğlu H. Management preferences of orthopedic surgeons in developmental dysplasia of the hip under 1 year of age in Türkiye: Results of a nationwide cross-sectional survey. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2023; 57:322-328. [PMID: 38131337 PMCID: PMC10837523 DOI: 10.5152/j.aott.2023.23080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study aimed to evaluate the diagnosis and treatment preferences of orthopedic surgeons in developmental dysplasia of the hip (DDH) cases under the age of 1 in Türkiye with a higher incidence of DDH, estimated to be around 5-15 per 1000 live births. METHODS This was a nationwide cross-sectional survey. A link for the online survey, including 16 multiple-choice questions, was sent to the email group of the National Orthopedic Society. RESULTS Among 233 filled-out surveys, 211 met the inclusion criteria. Half of the participants had experience of <10 years as orthopedic surgeons, managed <25% of pediatric patients in daily practice, and treated <25 DDH cases per year before walking age. Ninety-seven percent used more than one method, hip ultrasound the most common, for exact diagnosis of DDH under 6 months. Pavlik harness was the most commonly preferred brace, but the use of Tübingen orthosis increased among experienced surgeons. The uppermost age limit for bracing was higher in surgeons dealing with more pediatric patients and treating more DDH cases. Dislocated hips and hips requiring closed/open reduction were more commonly referred to other surgeons by less experienced surgeons in terms of years, number of pediatric patients, and treated DDH cases per year. The lowest age limit for intervention under general anesthesia was lower in surgeons treating >25 DDH cases per year. Over one-third used both anterior and medial approach open reduction, but a trend to anterior open reduction alone was more evident in surgeons treating >50 DDH cases per year. More experienced surgeons were more prone to check the intraoperative reduction with postoperative computed tomography or magnetic resonance imaging. Diagnosis and treatment ages of DDH cases did not significantly change during the coronavirus disease 2019 pandemic. CONCLUSION Management preferences of orthopedic surgeons in DDH before walking age primarily depend on the rate of pediatric patients in daily practice and the number of treated DDH cases per year.
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Affiliation(s)
- Baki Volkan Çetin
- Department of Orthopaedics and Traumatology, Harran University, Faculty of Medicine, Şanlıurfa, Turkey
| | - Sancar Bakırcıoğlu
- Department of Orthopaedics and Traumatology, TOBB Economy and Technology University, Ankara, Turkey
| | - Sadettin Çiftci
- Department of Orthopaedics and Traumatology, Selçuk University, Faculty of Medicine, Konya, Turkey
| | - Mehmet Salih Söylemez
- Department of Orthopaedics and Traumatology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Serkan Erkuş
- Department of Orthopaedics and Traumatology, Medifema Hospital, İzmir, Turkey
| | - Yalçın Turhan
- Department of Orthopaedics and Traumatology, Düzce University, Faculty of Medicine, Düzce, Turkey
| | - İsmet Yalkın Çamurcu
- Department of Orthopaedics and Traumatology, Aritmi Osmangazi Hospital, Bursa, Turkey
| | - Serda Duman
- Department of Orthopaedics and Traumatology, Baltalimanı Metin Sabancı Bone Diseases Training and Research Hospital, İstanbul, Turkey
| | - Timur Yıldırım
- Department of Orthopaedics and Traumatology, İstanbul Nişantaşı University, İstanbul, Turkey
| | - Kaya Memişoğlu
- Department of Orthopaedics and Traumatology, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Hakan Şenaran
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University, School of Medicine, İstanbul, Turkey
| | - Hakan Ömeroğlu
- Department of Orthopaedics and Traumatology, Ufuk University, Faculty of Medicine, Ankara, Turkey
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Lamback EB, Chiarini S, Roposch A, Dattani MT. Congenital growth hormone deficiency associated with hip dysplasia and Legg-Calve-Perthes disease. Clin Endocrinol (Oxf) 2021; 94:590-597. [PMID: 33147364 DOI: 10.1111/cen.14365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/11/2020] [Accepted: 11/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Growth hormone deficiency (GHD) is usually treated with recombinant human GH (rhGH), and this has been rarely associated with hip disorders. We analysed the clinical data of patients with congenital GHD receiving rhGH who had associated hip dysplasia or Legg-Calve-Perthes disease (LCPD), with a view to determining whether the hip dysplasia was associated with the underlying disease or with rhGH treatment. DESIGN We performed a retrospective analysis of paediatric and adolescent patients seen between 1992-2018 with congenital GHD and hip disorders. Data were collected through a review of the patients' medical records and included demographics, clinical and imaging data, and the time frame between the onset of the symptoms related to the hip disorders and the onset of GH treatment. RESULTS Of the 13 patients with hip disorders, hip dysplasia was present in ten patients and LCPD in three. Hip dysplasia was diagnosed before rhGH was initiated in 50% of cases. These patients had bilateral hip dysplasia and isolated GHD. LCPD was diagnosed in one patient before rhGH was commenced and did not progress. In two patients, LCPD was diagnosed after rhGH was started and did temporarily progress in one of them, but rhGH was not discontinued because LCPD did not seem to be related to rhGH treatment. CONCLUSIONS This study suggests that hip dysplasia could be a manifestation of an underlying GHD. Additionally, rhGH treatment may not necessarily be causative of LCPD.
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Affiliation(s)
| | | | | | - Mehul T Dattani
- Great Ormond Street Hospital for Children, London, UK
- UCL GOS Institute of Child Health, University College London, London, UK
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Chater A, Milton S, Green J, Gilworth G, Roposch A. Understanding physician behaviour in the 6-8 weeks hip check in primary care: a qualitative study using the COM-B. BMJ Open 2021; 11:e044114. [PMID: 33741671 PMCID: PMC7986785 DOI: 10.1136/bmjopen-2020-044114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES A compulsory hip check is performed on an infant at 6-8 weeks in primary care for the detection of developmental dysplasia of the hip (DDH). Missed diagnoses and infants incorrectly labelled with DDH remain an important problem. The nature of physician behaviour as a likely source of this problem has not been explored. The aims of this study were to make a behavioural diagnosis of general practitioners (GPs) who perform these hip checks, and identify potential behavioural change techniques that could make the hip checks more effective. DESIGN Qualitative study with in-depth semistructured interviews of 6-8 weeks checks. We used the Capability, Opportunity, Motivation and Behaviour model in making a behavioural diagnosis and elicited factors that can be linked to improving the assessment. SETTING Primary care. PARTICIPANTS 17 GPs (15 female) who had between 5 and 34 years of work experience were interviewed. RESULTS Capability related to knowledge of evidence-based criteria and skill to identify DDH were important behavioural factors. Both physical (clinic time and space) and social (practice norms), opportunity were essential for optimal behaviour. Furthermore, motivation related to the importance of the 6-8 weeks check and confidence to perform the check and refer appropriately were identified in the behavioural diagnosis. CONCLUSION Aspects of capability, opportunity and motivation affect GPs' diagnosis and referral behaviours in relation to DDH. The findings from this work extend current knowledge and will inform the development of an intervention aimed at improving the diagnosis of DDH.
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Affiliation(s)
- Angel Chater
- Department of Sport Science and Physical, University of Bedfordshire, Luton, UK
| | - Sarah Milton
- Department of Population Health Sciences, King's College London, London, UK
| | - Judith Green
- Department of Population Health Sciences, King's College London, London, UK
| | - Gill Gilworth
- Department of Population Health Sciences, King's College London, London, UK
| | - Andreas Roposch
- Institute of Child Health, University College London, London, UK
- Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, London, UK
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5
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Xu W, Shu L, Gong P, Huang C, Xu J, Zhao J, Shu Q, Zhu M, Qi G, Zhao G, Yu G. A Deep-Learning Aided Diagnostic System in Assessing Developmental Dysplasia of the Hip on Pediatric Pelvic Radiographs. Front Pediatr 2021; 9:785480. [PMID: 35356707 PMCID: PMC8959123 DOI: 10.3389/fped.2021.785480] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a common orthopedic disease in children. In clinical surgery, it is essential to quickly and accurately locate the exact position of the lesion, and there are still some controversies relating to DDH status. We adopt artificial intelligence (AI) to solve the above problems. METHODS In this paper, automatic DDH measurements and classifications were achieved using a three-stage pipeline. In the first stage, we used Mask-RCNN to detect the local features of the image and segment the bony pelvis, including the ilium, pubis, ischium, and femoral heads. For the second stage, local image patches focused on semantically related areas for DDH landmarks were extracted by high-resolution network (HRNet). In the third stage, some radiographic results are obtained. In the above process, we used 1,265 patient x-ray samples as the training set and 133 samples from two other medical institutions as the verification set. The results of AI were compared with three orthopedic surgeons for reliability and time consumption. RESULTS AI-aided diagnostic system's Tönnis and International Hip Dysplasia Institute (IHDI) classification accuracies for both hips ranged from 0.86 to 0.95. The measurements of numerical indices showed that there was no statistically significant difference between surgeons and AI. Tönnis and IHDI indicators were similar across the AI system, intermediate surgeon, and junior surgeon. Among some objective interpretation indicators, such as acetabular index and CE angle, there were good stability and consistency among the four observers. Intraclass consistency of acetabular index and CE angle among surgeons was 0.79-0.98, while AI was 1.00. The measurement time required by AI was significantly less than that of the doctors. CONCLUSION The AI-aided diagnosis system can quickly and automatically measure important parameters and improve the quality of clinical diagnosis and screening referral process with a convenient and efficient way.
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Affiliation(s)
- Weize Xu
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, Hangzhou, China.,Department of Orthopedics, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liqi Shu
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Ping Gong
- Deepwise AI Lab, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing, China
| | - Chencui Huang
- Deepwise AI Lab, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing, China
| | - Jingxu Xu
- Deepwise AI Lab, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing, China
| | - Jingjiao Zhao
- Deepwise AI Lab, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing, China
| | - Qiang Shu
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, Hangzhou, China.,Sino-Finland Joint AI Laboratory for Child Health of Zhejiang Province, Beijing, China
| | - Ming Zhu
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, Hangzhou, China.,Department of Orthopedics, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Sino-Finland Joint AI Laboratory for Child Health of Zhejiang Province, Beijing, China
| | - Guoqiang Qi
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, Hangzhou, China.,Sino-Finland Joint AI Laboratory for Child Health of Zhejiang Province, Beijing, China
| | - Guoqiang Zhao
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, Hangzhou, China.,Department of Orthopedics, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Sino-Finland Joint AI Laboratory for Child Health of Zhejiang Province, Beijing, China
| | - Gang Yu
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,National Clinical Research Center for Child Health, Hangzhou, China.,Sino-Finland Joint AI Laboratory for Child Health of Zhejiang Province, Beijing, China
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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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7
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Barbosa RDO, Albernaz EP. Profile of Patients Diagnosed with Developmental Dysplasia of the Hip. Rev Bras Ortop 2019; 54:497-502. [PMID: 31736518 PMCID: PMC6855922 DOI: 10.1016/j.rbo.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/21/2018] [Indexed: 11/26/2022] Open
Abstract
Objective
To describe the profile of patients with developmental dysplasia of the hip (DDH) diagnosed by physical and ultrasound examination, with the implementation of a protocol for the treatment and follow-up of DDH.
Methods
A cross-sectional study with DDH patients born between January 2014 and December 2016, in the city of Pelotas, Southern Brazil. Ethnicity, gender, birth weight, fetal presentation, affected side of the hip, gestational age, maternal age and family history were considered. The data on the medical records were compared with the characteristics of the general population described on the Brazilian National Information System on Live Births (Sistema de Informação sobre Nascidos Vivos [SINASC]).
Results
A total of 33 DDH patients were identified, mostly female, with a four-fold higher probability of having the condition (
p
< 0.001); the left was the most affected side. No statistically significant association was found regarding the following factors: birth weight, gestational age, ethnicity, and maternal age. The newborns in breech presentation had a 15-fold higher probability of presenting DDH (
p
< 0.001). A total of 21 newborns required immediate treatment of the hips, since the ultrasound showed a Graf classification of IIb or higher, or the radiography showed dislocation in DDH patients older than 6 months of age.
Conclusion
Screening for DDH is essential in all newborns; physical examinations revealing alterations must be complemented with ultrasound imaging to avoid the delayed diagnosis of the condition.
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8
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Tan SHS, Wu CH, Wong KL, Hui JH. Correlations between ultrasonographic and subsequent radiographic findings of developmental dysplasia of the hips. Ultrasonography 2019; 38:43-51. [PMID: 31344996 PMCID: PMC6920622 DOI: 10.14366/usg.18064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 03/16/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose The study aimed to investigate the utility of ultrasonographic (US) findings in predicting the subsequent radiographic parameters of developmental dysplasia of the hips. Methods In this 12-year retrospective cohort study, all new-born infants with a positive clinical examination or risk factors were included. They were scheduled for hip ultrasonography in the first 3 months, and subsequent radiographs at 1 year of life. The US images were evaluated using the Graf classification, Harcke’s dynamic screening method, and Terjesen’s femoral head coverage method. The radiographic images were evaluated using the acetabular index and femoral head position. The overall US or radiographic findings were considered abnormal if they were classified as abnormal for any of their respective parameters. The overall US and radiographic parameters were correlated. Results A total of 160 patients were included. The overall US and radiographic parameters showed no statistically significant difference (P=0.050). The sensitivity, specificity, and accuracy of the overall US parameters were 57.1%, 84.9%, and 81.3%, respectively. All three individual US parameters showed no statistically significant differences, with the overall radiographic findings and acetabular index (P>0.05). However, they showed a statistically significant difference, with the position of the femoral head (P<0.001), with the US parameters having an excellent negative predictive value of 100% for identifying an abnormal femoral head position. Conclusion The current study suggests that US findings evaluated in the first 3 months of life showed no statistically significant difference with radiographic findings evaluated at 1 year of life. The US parameters showed an excellent negative predictive value for abnormal femoral head position on radiographs.
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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
| | - Cheng Han Wu
- 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
| | - James Hoipo Hui
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System (NUHS), Singapore
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9
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Marson BA, Hunter JB, Price KR. Value of the 'clicky hip' in selective screening for developmental dysplasia of the hip. Bone Joint J 2019; 101-B:635-638. [PMID: 31154832 DOI: 10.1302/0301-620x.101b6.bjj-2018-1238.r3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to review the value of accepting referrals for children with 'clicky hips' in a selective screening programme for hip dysplasia. PATIENTS AND METHODS A single-centre prospective database of all referrals to the hip clinic was examined to identify indication for referrals, diagnosis, and treatment. All patients referred received a standardized ultrasound scan and clinical examination by an orthopaedic consultant. RESULTS There were 5716 children referred to the orthopaedic hip clinic between 1 June 2014 and 26 September 2018. In all, 1754 children (30.1%) were referred due to 'clicky hip' with no additional risk factors or indications for ultrasound scan. A total of 123 children (7.1%) referred with 'clicky hip' and no additional risk factors or examination findings had an abnormal initial hip ultrasound, including 16 children (0.9%) with dysplastic hips. Of the 141 children who required treatment in a Pavlik harness during the study period, 23 (16%) had been referred with a 'clicky hip' and no additional risk factors or examination findings, including six children with Graf 3 or 4 hips. CONCLUSION There is significant value in reviewing children with an isolated 'clicky hip'. Many children who require treatment are referred to the orthopaedic service as 'clicky hip' with no additional risk factors. In a pragmatic pathway with a diverse population of clinicians performing baby checks, 'clicky hip' is an important indication for referral and should not be discarded. Cite this article: Bone Joint J 2019;101-B:635-638.
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Affiliation(s)
- B A Marson
- Department of Paediatric Orthopaedics, Nottingham Children's Hospital, Queens Medical Centre, Nottingham, UK
| | - J B Hunter
- Department of Paediatric Orthopaedics, Nottingham Children's Hospital, Queens Medical Centre, Nottingham, UK
| | - K R Price
- Department of Paediatric Orthopaedics, Nottingham Children's Hospital, Queens Medical Centre, Nottingham, UK
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10
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Incorporating risk factors in the development of the screening programme for developmental dysplasia of the hips. J Pediatr Orthop B 2019; 28:111-114. [PMID: 30461505 DOI: 10.1097/bpb.0000000000000567] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In a 12-year cohort study, all newborns with suspected developmental dysplasia of the hips (DDHs) were scheduled for hip ultrasound at the sixth week of life. Female sex is the only isolated risk factor with a positive likelihood ratio predictive of DDH [1.26; 95% confidence interval (CI): 1.04-1.54]. In combination, the presence of two or more risk factors was predictive of DDH (positive likelihood ratio 1.10; 95% CI: 1.00-1.20). The sensitivity and specificity of two or more risk factors for the prediction of DDH were 93.6% (95% CI: 86.6-97.6) and 14.5% (95% CI: 8.70-22.2), respectively. The level of evidence for the cohort study is II.
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Sakkers R, Pollet V. The natural history of abnormal ultrasound findings in hips of infants under six months of age. J Child Orthop 2018; 12:302-307. [PMID: 30154919 PMCID: PMC6090198 DOI: 10.1302/1863-2548.12.180056] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To collect and describe data on the natural history of abnormal ultrasound (US) findings in hips of infants under six months of age to serve as a reference to the design of screening programmes and treatment algorithms in the care for children with hip dysplasia. METHODS A search in PubMed of the terms "DDH" and "ultrasound" was done to find hips with abnormal US findings that were not treated. In cases of multiple periods of follow-up, the classification of every period was evaluated separately (individual hip follow-up periods). RESULTS Data of 13 561 hips with 16 991 follow-up periods were collected and analyzed. Most quantifiable classifications and follow-up periods were according to Graf (14 876) and a minor number of the hips had follow-up periods with femoral head coverage (FHC) (2115). Normal development without treatment in the first six months was for Graf 2a between 89% and 98%, for Graf 2c between 80% and 100% and for clustered data Graf 2a to 2c between 80% and 97%. For Graf 3 hips more than 50% were reported to develop into normal hips without treatment. As for Graf 4 hips this percentage was reported below 50%. For children with an FHC less than 50%, normalization was reported between 78% and 100%. CONCLUSION The natural history of developmental dysplasia of the hip (DDH) shows a benign course, especially in the well-centered hips. This outcome probably contributes to the fact that all studies on US screening of hips for detection of relevant DDH in order to improve outcomes of treatment are rated as substantially underpowered.
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Affiliation(s)
- R. Sakkers
- Department of Orthopaedic Surgery, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands, Correspondenceshould be sent to R. Sakkers, Department of Orthopaedic Surgery, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Lundlaan 6, 3584EA Utrecht, The Netherlands. E-mail:
| | - V. Pollet
- Department of Orthopaedic Surgery, Birmingham Women’s and Children’s Hospital, Birmingham, UK
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12
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Alves C, Truong WH, Thompson MV, Suryavanshi JR, Penny CL, Do HT, Dodwell ER. Diagnostic and treatment preferences for developmental dysplasia of the hip: a survey of EPOS and POSNA members. J Child Orthop 2018; 12:236-244. [PMID: 29951123 PMCID: PMC6005222 DOI: 10.1302/1863-2548.12.180034] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of this study was to elucidate developmental dysplasia of the hip (DDH) diagnosis and treatment preferences among members of the Pediatric Orthopaedic Society of North America (POSNA) and European Paediatric Orthopaedic Society (EPOS). METHODS A 54-question survey on DDH diagnosis and treatment preferences was distributed to POSNA and EPOS members. Descriptive statistics were performed. RESULTS A total of 459 responses were analyzed. Ultrasound was the preferred modality for diagnosing DDH in infants less than six months old; few surgeons preferred radiographs. In all, 57% of POSNA members had radiology technicians perform ultrasounds, only 7% of EPOS members did. The percent coverage defining a dislocated hip varied greatly, the most frequent response being < 20% for POSNA and < 40% for EPOS members. Pavlik harnesses were the most popular harness/brace, used by 90% of POSNA and 71% of EPOS members. POSNA members were more likely than EPOS members to use a rigid abduction brace following initial harness/brace failure. For residual acetabular dysplasia, POSNA members were twice as likely as EPOS members to institute hip abduction bracing. Most surgeons would not perform closed reduction at less than three months of age or open reduction at less than six months of age. Most EPOS -members used traction prior to reduction; few POSNA members did. Few POSNA and EPOS members believed that reduction should be delayed until the ossific nucleus was visible. CONCLUSION There is great variation in the preferred methods for diagnosing and treating DDH. This survey is the largest transcontinental survey to compile diagnostic and treatment preferences for DDH. With wide variations in practice, there is room for quality improvement.
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Affiliation(s)
- C. Alves
- Hospital Pediatrico - CHUC, EPE, Avenida Afonso Romao, 3000-602, Coimbra, Portugal
| | - W. H. Truong
- Gillette Children’s Specialty Healthcare, St Paul, Minnesota, USA
| | | | | | - C. L. Penny
- Hospital for Special Surgery, New York, New York, USA
| | - H. T. Do
- Hospital for Special Surgery, New York, New York, USA
| | - E. R. Dodwell
- Hospital for Special Surgery, New York, New York, USA, Correspondence should be sent to E. Dodwell, Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021, United States. E-mail:
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13
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Wang N, Zhang YL, Guan BY, Zhu LL, He XH, Fang Q, Liang ZC. [An ultrasonographic study of the correlation between developmental dysplasia of the hip and congenital muscular torticollis in children]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:924-928. [PMID: 28736369 PMCID: PMC6765504 DOI: 10.3969/j.issn.1673-4254.2017.07.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the significance of early screening of pediatric developmental dysplasia of the hip (DDH) and congenital muscular torticollis (CMT) using ultrasonography and establish a simultaneous screening model for pediatric DDH and CMT. METHODS From January, 2013 to January, 2016, a total of 5060 pediatric patients with suspected DDH and CMT underwent ultrasonic examinations. The diagnostic results of the two diseases were classified into different clinical types, and Chi-square test was used to analyze the one-way relationship between different types of DDH and CMT; correspondence analysis was used for multivariate analysis of the variables. Chi-square test was used to analyze the difference between the detection rates in suspected CMT patients and the normal population. RESULTS GrafIIa type DDH was associated with mass-type CMT in the children (χ2=331.800, P<0.001). DDH of GrafIIb, GrafIIc, Graf III, and Graf IV types were related with non-tumor type of CMT. The children with a suspected diagnosis of CMT showed a significantly higher detection rate of DDH than the normal subjects (χ2=321.889, P<0.001). CONCLUSION DDH is closely related with CMT. Early simultaneous screening of DDH and CMT can help to improve the early diagnosis rate of CMT in children.
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Affiliation(s)
- Na Wang
- Department of Ultrasound, Guangzhou Women and Children's Medical Center, Guangzhou 510120, China.E-mail:
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Zargarbashi RH, Bonaki HN, Zadegan SA, Baghdadi T, Nabian MH, Shirazi MR. Comparison of Pediatric and General Orthopedic Surgeons' Approaches in Management of Developmental Dysplasia of the Hip and Flexible Flatfoot: the Road to Clinical Consensus. THE ARCHIVES OF BONE AND JOINT SURGERY 2017; 5:46-51. [PMID: 28271087 PMCID: PMC5339355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/15/2016] [Indexed: 06/06/2023]
Abstract
Developmental dysplasia of the hip (DDH) and flatfoot are common pediatric orthopedic disorders, being referred to and managed by both general and pediatric orthopedic surgeons, through various modalities. Our study aimed to evaluate their consensus and perspective disagreements in terms of diagnostic and therapeutic approaches of the mentioned deformities. Forty participants in two groups of general orthopedic surgeons (GOS) (n=20) and pediatric orthopedic surgeons (POS) (n=20), were asked to answer an 8-item questionnaire on DDH and flexible flatfoot. The questions were provided with two- or multiple choices and a single choice was accepted for each one. Chi-square and Fisher's exact tests was performed to compare the responses. For a neonate with limited hip abduction, hip ultrasonography was the agreed-upon approach in both groups (100% POS vs 71% GOS), and for its interpretation 79% of POS relied on their own whereas 73% of GOS relied on radiologist's report (P=0.002). In failure of a 3-week application of the Pavlik harness, ending it and closed reduction (57% POS vs. 41% GOS) followed by surgery quality assessment with CT scan (64% POS vs. 47% GOS) and without the necessity for avascular necrosis evaluation (79% POS vs. 73% GOS) were the choice measures. In case of closed reduction failure, open reduction via medial approach was the favorite next step in both groups (62% POS and 80% GOS). For the patient with flexible flat foot, reassurance was the choice plan of 79% of pediatric orthopedists. Our findings demonstrated significant disagreements among the orthopedic surgeons. This proposes insufficiency of high-level evidence.
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Affiliation(s)
- Ramin Haj Zargarbashi
- Orthopedics and Trauma Surgery Department, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hirbod Nasiri Bonaki
- Orthopedics and Trauma Surgery Department, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shayan Abdollah Zadegan
- Orthopedics and Trauma Surgery Department, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Taghi Baghdadi
- Orthopedics and Trauma Surgery Department, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Nabian
- Orthopedics and Trauma Surgery Department, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Ramezan Shirazi
- Orthopedics and Trauma Surgery Department, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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