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Guo Y, Li X, Yang D, Yedron N, Chen T, Li J, Lei Y, Li P, Ji J, Shi L, Yang X, Cho T. Plasma metabolomics signatures of developmental dysplasia of the hip in Tibet plateau. Orphanet J Rare Dis 2024; 19:228. [PMID: 38851765 PMCID: PMC11161931 DOI: 10.1186/s13023-024-03230-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/27/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a common childhood health complaint, whose etiology is multifactorial. The incidence of DDH is variable and higher in Tibet plateau. Here, we collected plasma samples and studied the metabolomics signatures of DDH. METHODS Fifty babies were enrolled: 25 with DDH and 25 age-matched non-DDH healthy controls (HC group). We collected plasma samples, laboratory parameters and conducted untargeted metabolomics profiling. RESULTS There are many differential metabolites among patients with DDH, including 4-β-hydroxymethyl-4-α-methyl-5-α-cholest-7-en-3-beta-ol, β-cryptoxanthin, α-tocopherol, taurocholic acid, glycocholic acid, 2-(3,4-dihydroxybenzoyloxy)-4,6-dihydroxybenzoate, arabinosylhypoxanthine, leucyl-hydroxyproline, hypoxanthine. The main differential metabolic pathways focused on primary bile acid biosynthesis, arginine and proline metabolism, phenylalanine metabolism, histidine metabolism, purine metabolism. CONCLUSIONS To our knowledge, this is the first report of metabolomics profile in babies with DHH. By combining the α-tocopherol and taurocholic acid, we could achieve the differential diagnosis of DDH.
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Affiliation(s)
- Ye Guo
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaogang Li
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- Medical Science Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - De Yang
- Department of Ultrasound, People's Hospital of Tibet Autonomous Region, No. 16, North Linkuo Road, Lhasa, Tibet, 850000, China
| | - Nyima Yedron
- Department of Ultrasound, People's Hospital of Tibet Autonomous Region, No. 16, North Linkuo Road, Lhasa, Tibet, 850000, China
| | - Tao Chen
- Department of Ultrasound, Beijing Jishuitan Hospital, The 4th Clinical College, Peking University, Xinjiekou Dongjie, Xicheng District, Beijing, 100035, China
| | - Jianchu Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan, Dong Cheng District, Beijing, 100730, China
| | - Yanming Lei
- Department of Radiology, People's Hospital of Tibet Autonomous Region, No. 16, North Linkuo Road, Lhasa, Tibet, 850000, China
| | - Ping Li
- Department of Infectious Diseases, People's Hospital of Tibet Autonomous Region, No.16, North Linkuo Road, Lhasa, Tibet, 850000, China
| | - Jiamei Ji
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan, Dong Cheng District, Beijing, 100730, China
| | - Li Shi
- Department of Laboratory Medicine, People's Hospital of Tibet Autonomous Region, No.16, North Linkuo Road, Lhasa, Tibet, 850000, China
| | - Xiao Yang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan, Dong Cheng District, Beijing, 100730, China.
| | - Ten Cho
- Department of Orthopedics, People's Hospital of Tibet Autonomous Region, No. 16, North Linkuo Road, Lhasa, Tibet, 850000, China.
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Caruso G, Gambuti E, Spadoni E, Filipponi S, Saracco A, Artioli F, Galla A, Massari L. Incidence of risk factors in developmental dysplasia of the hip: a retrospective study on 18,954 cases. Hip Int 2024:11207000241248416. [PMID: 38767233 DOI: 10.1177/11207000241248416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND DDH is 1 of the most important causes of childhood disability. A diagnosis of instability can be made in the neonatal period via the Ortolani and Barlow manoeuvres. However, clinical examination, although highly specific, has poor sensitivity as compared to ultrasound. There is controversy between the necessity of universal screening for dysplasia of all newborns or selective screening reserved for those with clinical signs of instability or known risk factors of DDH. AIM To analyse the risk factors of congenital hip dysplasia in a consecutive case series of children referred for diagnosis and treatment of DDH. MATERIALS AND METHODS This was a cross-sectional study on infants consecutively examined between January 2000 and December 2019 at the Marino Ortolani Centre in Ferrara, Italy. The first 3 types on Graf's classification were considered physiological (1A, 1B, 2A+), while the last 6 pathological (2A-, 2B, 2C, 2D, 3, 4). RESULTS 18,954 infants met the inclusion criteria and were therefore considered eligible for the study. Of these 18,954 infants, 56% (n = 10,629) were females and 44% (n = 8325) were males. According to Graf classification, 34.9% (n = 6621) were 1A, 52.7% (n = 9999) were 1B, 4.0% (n = 753) were 2A+, 2.5% (n = 478) were 2A-, 1.5% (n = 284) were 2B, 1% (n = 196) were 2C, 1.3% (n = 243) were 2D, 1% (n = 193) were 3 and 1.0% (n = 187) were 4. The most significant risk factor was the female gender (OR 5.36; 95% CI, 4.63-6.20) followed by a family history (OR 2.35; 95% CI, 2.08-2.65), then skeletal pathologies (OR 2.04; 95% CI, 1.21-3.42), oligohydramnios (OR 1.75; 95% CI, 1.44-2.13), and finally breech presentation (OR 1.42: 95% CI, 1.27-1.60). CONCLUSIONS Based on our data, family history, musculoskeletal disease, oligohydramnios and breech presentation are the main risk factors for DDH development, as is the female sex.
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Affiliation(s)
- Gaetano Caruso
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Edoardo Gambuti
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Elisa Spadoni
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Sara Filipponi
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Achille Saracco
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Francesca Artioli
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
- Marino Ortolani Centre for diagnosis and treatment of developmental dysplasia of the hip, Ferrara, Italy
| | - Ambra Galla
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Leo Massari
- Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy
- Orthopaedics and Traumatology Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
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Giorgi V, Apostolo G, Bertelè L. Treatment of developmental hip dysplasia with manual therapy following Pavlik harness failure: a case report with long-term follow-up. J Man Manip Ther 2024:1-10. [PMID: 38706305 DOI: 10.1080/10669817.2024.2349334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a common musculoskeletal disorder in newborns, ranging from mild dysplasia to complete dislocation. Early detection and intervention are crucial for managing DDH. However, in some cases, standard orthopedic treatments such as the Pavlik harness fail, and alternative approaches are needed. Our study explores the possibility that manual therapy, specifically the Mézières-Bertelè Method (MBM), could be beneficial in cases of DDH that are resistant to conventional treatments. CASE DESCRIPTION We present a case of a 20-month-old female who had been suffering from persistent DDH (Graf's type IIIC on the left), pain and limping, despite previous conventional treatments, including the Pavlik harness. The patient received daily MBM sessions for six months, followed by maintenance sessions every two months. OUTCOMES After undergoing the MBM treatment, the patient showed clinical improvements, such as normal neuromotor development and restored hip joint parameters. We observed normal walking and running abilities, and X-ray parameters returned to normal levels. The patient sustained positive outcomes during long-term follow-up until the age of 7. CONCLUSION The MBM manual therapy was used to treat a challenging case of DDH resistant to conventional treatment. This case report suggests a possible correlation between manual therapy and improved outcomes in resistant DDH and highlights the potential relevance of addressing the inherent musculoskeletal components of the condition.
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Affiliation(s)
- Valeria Giorgi
- Rehabilitation Center, Apostolo Foundation, Lecco, Italy
| | | | - Laura Bertelè
- Rehabilitation Center, Apostolo Foundation, Lecco, Italy
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Khired ZA, Zogel B, Darraj H, Asiri RK, Hennawi YB, Alhazmi SM. Community Awareness About Developmental Dysplasia of the Hip (DDH) in the Western and Southern Regions of Saudi Arabia. Cureus 2024; 16:e58442. [PMID: 38765418 PMCID: PMC11099687 DOI: 10.7759/cureus.58442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a disorder in which the hip joint does not develop normally in the pediatric age group. It is caused by a confluence of hereditary and environmental factors. We aimed to examine knowledge and awareness of DDH among the general population of the southern and western regions of Saudi Arabia. METHODOLOGY A cross-sectional survey-based study was conducted in the western and southern regions of Saudi Arabia. This study included adult male and female participants above 18 years of age. Data were collected using a validated electronic questionnaire that was disseminated via social media platforms. All data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY). RESULTS In this study, 1,232 participants were surveyed in Saudi Arabia. The majority were between 21 and 30 years old (663, 53.8%), unmarried (690, 56%), and had a baccalaureate or diploma certificate (886, 71.9%). Regarding knowledge of DDH, 86.4% of participants had poor knowledge of the causes of DDH, and 740 (60%) had poor overall knowledge of DDH. However, 492 (40%) participants had good knowledge. Respondents with a higher monthly income, those who were mothers, and those who obtained information from social media had a better awareness level. Concerning treatment, 531 (43.1%) participants were unsure about the best treatment for DDH, and 850 (69%) believed that early treatment was better. CONCLUSIONS According to our literature, DDH is highly prevalent among Saudi populations. However, our findings indicate that the majority of the Saudi population residing in the western and southern regions of Saudi Arabia lacks basic knowledge of DDH. All capable facilities, such as medical schools, hospitals, and primary healthcare centers, must impart cultural education about DDH to address this awareness gap.
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Affiliation(s)
| | - Basem Zogel
- Department of Medicine and Surgery, Jazan University, Jazan, SAU
| | - Hussam Darraj
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Rana K Asiri
- College of Medicine, Umm Al-Qura University, Makkah, SAU
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Alrashdi N, Alotaibi M, Alharthi M, Kashoo F, Alanazi S, Alanazi A, Alzhrani M, Alhussainan T, Alanazi R, Almutairi R, Ithurburn M. Incidence, Prevalence, Risk Factors, and Clinical Treatment for Children with Developmental Dysplasia of the Hip in Saudi Arabia. A Systematic Review. J Epidemiol Glob Health 2024:10.1007/s44197-024-00217-5. [PMID: 38483754 DOI: 10.1007/s44197-024-00217-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/09/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) leads to pain, joint instability, and early degenerative joint disease. Incidence, prevalence, and management strategies of DDH have been well-documented in several countries, but not in Saudi Arabia. OBJECTIVE We synthesized the current evidence regarding incidence, prevalence, risk factors, and clinical treatment for children with DDH in Saudi Arabia. METHODS We searched 3 databases to locate studies. Studies that included children with DDH in Saudi Arabia; reported either incidence rate, prevalence, risk factors, and/or clinical practice; and were available in English or Arabic were included. We excluded reviews, case studies, or animal studies. Two independent authors reviewed potential studies and assessed study's quality. RESULTS Our search yielded 67 potential studies, of which 16 studies were included (total DDH sample = 3,127; age range = 2.5 to 86.4 months). Three studies reported incidence rates ranging from 3.1 to 4.9 per 1000 births, and 3 studies reported prevalence ranging from 6 to 78%. Nine studies reported that female sex, breech position, family history, and age less than 3 years were risk factors associated with DDH. Four studies reported that brace applications and closed reduction were conservative treatments, and 9 studies reported that open hip reduction, adductor tenotomy, and/or pelvic osteotomy were surgical approaches to treat DDH. CONCLUSIONS In Saudi Arabia, the Incidence and prevalence rates of DDH are 3.1 to 4.9 per 1,000 births, and 6-78%, respectively (differ from what has been reported in other countries), but the risk factors of DDH in Saudi Arabia appear to be similar in comparison to other countries (female, breech presentation, family history of DDH).
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Affiliation(s)
- Naif Alrashdi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, 11952, Saudi Arabia.
| | - Mansour Alotaibi
- Department of Physical Therapy, College of Applied Medical Sciences, Northern Border University, Arar, Saudi Arabia
| | - Moqfa Alharthi
- Rehabilitation Services Department, King Abdullah Specialized Children's Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Faizan Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, 11952, Saudi Arabia
| | - Sultan Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, 11952, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, 11952, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, 11952, Saudi Arabia
| | - Thamer Alhussainan
- Department of Orthopedics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Rami Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, 11952, Saudi Arabia
- Department of Physical Therapy and Rehabilitation, King Khaled Hospital, Almajmaah, Saudi Arabia
| | - Rakan Almutairi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, AL-Majmaah, 11952, Saudi Arabia
- Physiotherapy Department, Al Iman General Hospital, Riyadh First Health Cluster, Riyadh, Saudi Arabia
| | - Matthew Ithurburn
- American Sports Medicine Institute, Birmingham, AL, USA
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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Krysta W, Dudek P, Pulik Ł, Łęgosz P. Screening of Developmental Dysplasia of the Hip in Europe: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:97. [PMID: 38255410 PMCID: PMC10814691 DOI: 10.3390/children11010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a prevalent orthopaedic disorder in children, and screening methods vary across regions due to local health policies. The purpose of this review is to systematise the different ultrasound screening strategies for detecting DDH in newborns in Europe. METHODS Eligible studies from the PubMed, Embase, and Scopus databases, published between 1 January 2018 and 18 March 2023, were included. The inclusion criteria specified a European origin, a focus on newborn human patients, and information on ultrasound for DDH detection. RESULTS In total, 45 studies were included, covering 18 countries. Among them, six nations (Austria, Bosnia and Herzegovina, Poland, Slovenia, the Czech Republic, and Germany) perform universal ultrasound screening. The timing of the first ultrasound varies, with Austria and the Czech Republic within the 1st week, Bosnia and Herzegovina on the day of birth, Poland between 1 and 12 weeks, and Germany before the 6th week. The Graf method is the most popular ultrasound technique used. CONCLUSIONS There is no consensus on the optimal DDH detection approach in Europe. Varied screening methods stem from epidemiological, cultural, and economic differences among countries.
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Affiliation(s)
- Wojciech Krysta
- Student Scientific Association of Reconstructive and Oncology Orthopaedics, Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland; (W.K.); (P.D.)
| | - Patryk Dudek
- Student Scientific Association of Reconstructive and Oncology Orthopaedics, Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland; (W.K.); (P.D.)
| | - Łukasz Pulik
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland;
| | - Paweł Łęgosz
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland;
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Yoshioka-Maeda K, Honda C, Matsumoto H, Kinjo T, Fujiwara K, Aoki K. Developing an Educational Program for Ultrasound Hip Screening during Newborn and Infant Home Visits: A Protocol Paper. NURSING REPORTS 2024; 14:140-147. [PMID: 38251190 PMCID: PMC10801476 DOI: 10.3390/nursrep14010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/27/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Ultrasound hip screening is suitable for the early identification of developmental dysplasia of the hip (DDH). Newborn and infant home visits are good opportunities for hip screening in the community, but studies focusing on nurse-led screenings are lacking. Based on a pre-post design, this study aims to develop and evaluate an ultrasound training program to improve nurses' assessment skills in detecting DDH cases during newborn and infant home visits. Said educational program will include e-learning, hands-on seminars, and clinical training. The primary outcome will be the success rate of imaging standard planes (standardized images for hip assessment) in clinical training. The secondary outcomes will include knowledge test results, objective structured clinical examination scores, time required for imaging, and inter-rater reliability between nurses and physicians. The educational program will address the issue of missed and late detection of DDH cases in resource-limited communities. This study will demonstrate the feasibility of procedures and the effectiveness of the educational program in 2024. The protocol was registered in the University Hospital Medical Information Network Clinical Trial Registry before starting the study (no. UMIN000051929, 16 August 2023).
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Affiliation(s)
- Kyoko Yoshioka-Maeda
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan; (C.H.); (H.M.)
| | - Chikako Honda
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan; (C.H.); (H.M.)
| | - Hiroshige Matsumoto
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo 113-0033, Japan; (C.H.); (H.M.)
| | - Takeshi Kinjo
- Department of Orthopedic Surgery, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center, Haebaru Town, Okinawa 901-1193, Japan;
| | | | - Kiyoshi Aoki
- Department of Orthopedic Surgery, Asahigawasou Rehabilitation and Medical Center, Okayama 703-8207, Japan;
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Yasin MS, Al Karmi J, Suleiman DO, Raja YM, Alshrouf MA, Abu Halaweh A, Hamdan M, Samarah O. Acetabular index as an indicator of Pavlik harness success in grade I developmental dysplasia of the hip: A retrospective study. J Child Orthop 2023; 17:598-606. [PMID: 38050594 PMCID: PMC10693839 DOI: 10.1177/18632521231199519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/16/2023] [Indexed: 12/06/2023] Open
Abstract
Purpose Some articles have focused on the effectiveness of the Pavlik harness treatment for unstable and dislocated hips, yet data on monitoring its effectiveness with the acetabular index remains elusive. Therefore, this study aimed to assess Pavlik harness effectiveness in infants ≤6 months diagnosed with grade I developmental dysplasia of the hip using acetabular index improvement and identify the possible predictors of successful Pavlik harness treatment. Methods A retrospective review of infants with grade I acetabular dysplasia treated with a Pavlik harness and monitored with anteroposterior pelvis X-rays at presentation and follow-up. Successful treatment was defined as achieving an acetabular index <30°. Results A total of 231 infants with acetabular dysplasia were treated with a Pavlik harness. A successful outcome was achieved in 135 infants (58.4%). Younger age, lower initial acetabular index, and patients with unilateral developmental dysplasia of the hip were significant predictors of a successful outcome. An age of 4.5 months or older was found to be the threshold for an unsuccessful result following Pavlik harness treatment, with a sensitivity of 65.2% and specificity of 57.3%. An initial acetabular index of 35.5° was found to be the threshold for an unsuccessful result, with a sensitivity of 83.7% and specificity of 61.5%. Conclusion Pavlik Harness's success in correcting the acetabular index in acetabular dysplasia patients was related to unilateral cases, a younger age at presentation, and a lower initial acetabular index. The thresholds for unsuccessful treatment were an age of 4.5 months or greater and an acetabular index of 35.5° or higher.
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Affiliation(s)
- Mohamad Samih Yasin
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Joud Al Karmi
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Mohammad A Alshrouf
- Medical Internship, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Ahmad Abu Halaweh
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Hamdan
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Omar Samarah
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
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Yoshioka-Maeda K, Matsumoto H, Inagaki-Asano A, Honda C. Community-Based Hip Screening for Up to Four-Month-Old Infants and Health Guidance for Their Caregivers in Japan: A Nation-Wide Survey. NURSING REPORTS 2023; 13:1442-1451. [PMID: 37873828 PMCID: PMC10594427 DOI: 10.3390/nursrep13040121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
Early detection of developmental dysplasia of the hip (DDH) in children is crucial. Due to COVID-19, maternal and child health services have been suspended temporarily, increasing the risk of late detection of DDH. This study aimed to reveal Japan's current situation regarding community hip screening for newborns and infants and to provide health guidance for caregivers regarding DDH. A web-based, nationwide cross-sectional survey was conducted between February and March 2023 (n = 1737). One public health nurse overseeing maternal and child health per municipality responded to the 2022 municipality hip screening system. Among the 436 municipalities that responded (response rate: 25.1%), 97.5% implemented hip screening within 4 months, and approximately 60% performed it during newborn home visits, while only 2.3% conducted hip ultrasound screening. Perfect checking of the risk factors for DDH during newborn home visits and training opportunities for home visitors must be improved. Educational programs regarding DDH for home visitors and caregivers are needed to prevent the late diagnosis of DDH. Furthermore, collaboration between pediatric orthopedic surgeons and nurses is crucial for developing effective community-based hip-screening systems by bridging the evidence and practice gap in the early detection of DDH.
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Affiliation(s)
- Kyoko Yoshioka-Maeda
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Faculty of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (H.M.); (C.H.)
| | - Hiroshige Matsumoto
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Faculty of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (H.M.); (C.H.)
| | - Asa Inagaki-Asano
- Department of Gerontological Home Care and Long-Term Care Nursing, Division of Health Sciences and Nursing, Faculty of Medicine, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Chikako Honda
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Faculty of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (H.M.); (C.H.)
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Lin CR, Chou H, Luo CA, Chang SH. A Novel Technique for Autograft Preparation Using Patient-Specific Instrumentation (PSI) Assistance in Total Hip Arthroplasty in Developmental Dysplasia of Hip (DDH). J Pers Med 2023; 13:1331. [PMID: 37763099 PMCID: PMC10532815 DOI: 10.3390/jpm13091331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Due to the change in the structure of the proximal femur and acetabulum in patients with developmental dysplasia of the hip, total hip arthroplasty (THA) was difficult to perform for surgeons. To elevate the acetabular coverage rate, we developed a technique in the use of a patient-specific instrumentation (PSI) graft in patients with developmental dysplasia of hip (DDH) undergoing surgery. This study aims to evaluate the peri-operative outcomes of THA with PSI graft in patients with DDH. This study recruited 6 patients suffering from Crowe I DDH with secondary Grade IV osteoarthritis. All the patients underwent THA with PSI graft performed by a well-experienced surgeon. Perioperative outcomes included surgical procedures, blood loss during operation, the volume of blood transfusion, length of hospitalization, complications, and the mean difference in hemoglobin levels before and after surgery. All the outcomes analyzed were assessed by mean and standard deviation. The average duration of the surgical procedure was found to be 221.17 min, with an SD of 19.65 min. The mean blood loss during the operation was 733.33 mL, with an SD of 355.90 mL. The mean length of hospital stay was calculated to be 6 days, with an SD of 0.89 days. Furthermore, the mean difference between the pre- and postoperative hemoglobin levels was 2.15, with an SD of 0.99. A total of three patients received 2 units of leukocyte-poor red blood cells (LPR) as an accepted blood transfusion. There were no reported complications observed during the admission and one month after the operation. This study reported the peri-operative outcomes in the patients with DDH who underwent THA with PSI graft. We found that THA with PSI graft would provide a safe procedure without significant complications. We assumed that the PSI graft in THA may increase the coverage rate of the acetabulum, which may increase the graft union rates. Further cohort studies and randomized controlled trials were needed to confirm our findings.
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Affiliation(s)
- Chun-Ru Lin
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing Street, Guishan District, Taoyuan City 333423, Taiwan;
| | - Hsuan Chou
- School of Medicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Road, Xinzhuang District, New Taipei City 24205, Taiwan;
| | - Chu-An Luo
- Department of Precision Surgery Development, A Plus Biotechnology Co., Ltd., 6F, No. 23, Qiaohe Road, Zhonghe District, New Taipei City 23529, Taiwan;
| | - Shu-Hao Chang
- School of Medicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Road, Xinzhuang District, New Taipei City 24205, Taiwan;
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City 24352, Taiwan
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Merckaert S, Zambelli PY. Treatment perspective after failed open reduction of congenital hip dislocation. A systematic review. Front Pediatr 2023; 11:1146332. [PMID: 37622079 PMCID: PMC10445129 DOI: 10.3389/fped.2023.1146332] [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: 01/17/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
Background Failure of open reduction of developmental hip dislocation is a serious complication and revision surgery appear to be technically demanding with high complication rates. Little attention has been given in literature to patients in whom open reduction of developmental hip dislocation has failed. We present a systematic review about current perspectives and timing when to perform surgical revision after failed open reduction of developmental hip dislocation in children. Methods Following the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) statements we performed a comprehensive search of the PubMed and Google Scholar bibliographic database in order to select all studies published between 1980 and 2022. Studies were screened for the reasons for failure of open reduction, timing when revision surgery was performed, and for the surgical techniques used for revision. Results A total of 10 articles including 252 patients and 268 hips has been recorded. The most common causes of re-dislocation after open reduction are inadequate exposure and failure to release the obstructing soft tissues inside and around the hip. In 90% of the cases the anterolateral approach was performed for revision surgery. Avascular necrosis occurred in 5%-67% of cases and was the most encountered complication. Conclusion Redislocation of developmental hip dislocation after an open reduction has poor long-term outcomes mainly due to a high rate of avascular necrosis of the femoral head. It is mandatory to obtain a stable reduction at the second surgery combining soft tissue release, capsulorrhaphy, pelvic and femoral osteotomies.
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Affiliation(s)
- Sophie Merckaert
- Unit of Pediatric Orthopedics, Department of Women-Mother – Child’s Care, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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12
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Li Y, Wang Z, Miao M, Xu Y, Shi J. Residual acetabular dysplasia after Pavlik harness treatment for Graf type II hips. J Child Orthop 2023; 17:306-314. [PMID: 37565002 PMCID: PMC10411375 DOI: 10.1177/18632521231182423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/29/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose To evaluate the residual acetabular dysplasia in Graf type II hips after Pavlik harness treatment with a radiographic follow-up at 2 years of age. Methods We retrospectively reviewed the developmental dysplasia of the hip patients who were treated with the Pavlik harness between March 2018 and February 2022. Patients with Graf type II hip dysplasia who had at least one radiographic follow-up after 2 years of age were included. The following information, sex, laterality, affected side, age at harness initiation, treatment duration, α angle, and the morphology of bony roof, was collected and studied. We evaluated the radiographic acetabular index at the last follow-up and defined the value of greater than 2 standard deviations as residual acetabular dysplasia. Results A total of 33 patients (53 hips) met the criteria. The mean initial α angle was 53.4°; the mean age at Pavlik harness initiation was 10.9 weeks. The mean treatment duration was 10 weeks. The mean α angle at the last ultrasound follow-up was 64.9°. The mean age of the last radiographic follow-up was 2.6 years, and 26 hips had a residual acetabular dysplasia with acetabular indexes greater than 2 standard deviations above the mean. The morphology of the acetabular bony rim (odds ratio = 4.333, P = 0.029) and age of initial treatment <12 weeks (odds ratio = 7.113, P = 0.014) were seen as significant predictors for a higher acetabular index more than 2 years of age. Conclusions A notable incidence of residual acetabular dysplasia after Pavlik harness treatment in Graf type II hips, wherein the acetabular bony roof with a blunt rim at the end of treatment and initial age after 12 weeks were independent predictors associated with residual acetabular dysplasia. Levels of evidence Therapeutic studies, IV.
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Affiliation(s)
- Yuchan Li
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhigang Wang
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyuan Miao
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunlan Xu
- Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Shi
- Department of Radiology, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Dawod MS, Alswerki MN, Abuqudiri AZ, Albadaineh AA, Mahmoud LM, Altarawneh DJ, Rbeihat NH, Alkhanazreh RM. The Impact of Maternal Age and Educational Level on Developmental Dysplasia of the Hip Diagnosis and Screening: A Descriptive Comparative Study. Adv Orthop 2023; 2023:6793645. [PMID: 37275323 PMCID: PMC10234724 DOI: 10.1155/2023/6793645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/05/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023] Open
Abstract
Background Early and proper screening for developmental dysplasia of the hip (DDH) is very critical to prevent catastrophic complication on the developing hip joint. Many factors (either maternal or child-related) that hinder timely DDH screening have been previously investigated. Methods A cross-sectional descriptive study design was adopted. 175 babies presented for DDH screening coming with their mothers were investigated. Maternal age, age group, and educational level were recorded. In addition, multiple child-related variables such as age of screening, gender, positive family history, preterm delivery, and mode of delivery were recorded as well. Analysis for association between delayed vs. early screening was made against the maternal and the child-related variables. Results A total number of 175 children with their mothers were investigated. The mean maternal age was 27.9 years, about one third of the mothers had a graduate level of education (36.3%), while 41.1% had high school education, and 22.3% had middle school education. On the other hand, 40.0% of the investigated babies were first born and two thirds of our sample babies were females (66.9%). Of the included babies, 100 (57.1%) were screened at the appropriate 4-month age, while 75 (42.9%) missed the 4-month screening. Chi-square analysis showed that delayed DDH screening was associated with a lower maternal educational level (P ≤ 0.001), younger maternal age (P ≤ 0.001), and first born baby (P ≤ 0.001). Positive family history was protective against delayed DDH screening (P = 0.032). Conclusion The lower maternal educational level, younger maternal age group, and first born babies are risk factors for delayed DDH screening.
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Aslam F, Jamil K, Htwe O, Yuliawiratman BS, Natarajan E, Elamvazuthi I, Naicker AS. Postsurgical Analysis of Gait, Radiological, and Functional Outcomes in Children with Developmental Dysplasia of the Hip. SENSORS (BASEL, SWITZERLAND) 2023; 23:3386. [PMID: 37050445 PMCID: PMC10098631 DOI: 10.3390/s23073386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Children undergoing DDH correction surgery may experience gait abnormalities following soft tissue releases and bony procedures. The purpose of this study was to compare the residual gait changes, radiological outcomes, and functional outcomes in children who underwent DDH surgery with those in healthy controls. METHODS Inertial motion sensors were used to record the gait of 14 children with DDH and 14 healthy children. Pelvic X-ray was performed to determine the Severin classification and the presence of femoral head osteonecrosis (Bucholz-Odgen classification). For functional evaluation, the Children's Hospital Oakland Hip Evaluation Scale (CHOHES) was used. RESULTS There was no difference in spatial parameters between the two groups. In terms of temporal parameters, the DDH-affected limbs had a shorter stance phase (p < 0.001) and a longer swing phase (p < 0.001) than the control group. The kinematic study showed that the affected limb group had smaller hip adduction angle (p = 0.002) and increased internal rotation (p = 0.006) with reduced upward pelvic tilt (p = 0.020). Osteonecrosis was graded II, III, and IV in five, three, and one patients, respectively. Five patients had no AVN changes. The Severin classification was grade I, II, and III for six, three, and five patients, respectively. Most patients had good functional outcomes on the CHOHES, with a mean total score of 96.64 ± 5.719. Multivariate regression analysis revealed that weight, height, and femoral osteotomy were independent predictors for gait, radiological and functional outcome. CONCLUSION Despite good functional scores overall, some children had poor radiological outcomes and gait abnormalities. Our results identified the risk factors for poor outcomes, and we recommend specified rehabilitative strategies for long-term management.
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Affiliation(s)
- Firdaus Aslam
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Cheras, Kuala Lumpur 56000, Malaysia
| | - Kamal Jamil
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Cheras, Kuala Lumpur 56000, Malaysia
| | - Ohnmar Htwe
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Cheras, Kuala Lumpur 56000, Malaysia
| | - Brenda Saria Yuliawiratman
- IHT Rehabilitation Centre, Jalan Bioteknologi 1, Persiaran SILC, Kawasan Perindustrian SILC, lskandar Puteri 79200, Johor, Malaysia
| | - Elango Natarajan
- Faculty of Engineering, Technology and Built Environment, UCSI University, Kuala Lumpur 56000, Malaysia
| | - Irraivan Elamvazuthi
- Department of Electrical & Electronic Engineering, Universiti Teknologi Petronas, Seri Iskandar 32610, Perak, Malaysia
| | - Amaramalar Selvi Naicker
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Cheras, Kuala Lumpur 56000, Malaysia
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15
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Han J, Li Y. Progress in screening strategies for neonatal developmental dysplasia of the hip. Front Surg 2022; 9:995949. [PMID: 36386514 PMCID: PMC9644127 DOI: 10.3389/fsurg.2022.995949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/05/2022] [Indexed: 01/24/2023] Open
Abstract
Developmental dysplasia of the hip (DDH) is the most common congenital disease of the musculoskeletal system in newborns and encompasses a disease spectrum ranging from a stable hip with a mildly dysplastic acetabulum to complete hip dislocation. Systematic screening for infant DDH has been performed for several decades all over the world and has contributed greatly to the early detection, diagnosis and treatment of DDH. However, some cases of delayed diagnosis still occur among the screened population, or conversely, overdiagnosis or overtreatment occasionally occurs. Furthermore, screening strategies for DDH are still controversial. The aim of our study was to analyze the current literature on DDH screening, paying particular attention to DDH screening strategies and their effectiveness. We searched the DDH screening literature from 1958 to 2021 in MEDLINE and other databases using PubMed. In this study, we reviewed the history of DDH screening and the progress of screening strategies and discussed the controversies regarding clinical and ultrasound screening methods with particular emphasis on the current opinions. Given the existing scientific evidence and changes in newborn DDH screening practices, universal ultrasound screening seems to be the best option for preventing late-detected cases and can be recommended as a favorable prevention strategy.
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Affiliation(s)
- Jiuhui Han
- Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China,Correspondence: Jiuhui Han
| | - Yu Li
- Department of Orthopaedics, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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16
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Angsanuntsukh C, Patathong T, Klaewkasikum K, Jungtheerapanich W, Saisongcroh T, Mulpruek P, Woratanarat P. Factors for selective ultrasound screening in newborns with developmental dysplasia of the hip (DDH). Front Surg 2022; 9:1038066. [DOI: 10.3389/fsurg.2022.1038066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
BackgroundHip ultrasound screening for DDH provides better sensitivity compared to physical examination. Due to a lower prevalence and limited resources, selective hip ultrasound in newborns at risk could be considered a proper screening protocol in Thailand and Asian countries.ObjectiveThis study was aimed to evaluate risk factors and define criteria for selective screening.MethodsA case-control study was conducted in 2020. All newborns with hip ultrasound screening were included. Cases were defined as newborns with abnormal hip ultrasounds, while controls were those with normal studies. Inter and intra-rater reliability were evaluated. All factors were analyzed using univariate and multivariate logistic regression. The model performance was tested by Hosmer-Lemeshow goodness of fit. Internal validity was performed by the split data method. Area under the receiver operating characteristic (ROC) curve was estimated.ResultsNinety-five newborns (29 cases and 66 controls) were included. Eighty percent of cases and 58% of controls were female. The gestational age was 36.6 and 37.7 weeks in case and control, respectively. Female, breech presentation, positive Ortolani test, positive Barlow test, and limited hip abduction were significant factors with odds ratio of 2.82, 5.12, 34.21, 69.64, and 5.48, respectively. The final model included breech presentation, positive Ortolani test, and positive Barlow test. The model cut-off value 15.02 provided sensitivity (93.10%) and specificity were (80.30%). The area under the ROC curve was 0.9308. The split data remained significant internal validity for all factors with p-value < 0.05.ConclusionCareful history taking and physical examination are essential to identify the risk factors for DDH. Newborns with breech presentation, positive Ortolani test and positive Barlow test should be screened by hip ultrasound.
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Pulik Ł, Płoszka K, Romaniuk K, Sibilska A, Jedynak A, Tołwiński I, Kumięga P, Wojtyński P, Łęgosz P. Impact of Multiple Factors on the Incidence of Developmental Dysplasia of the Hip: Risk Assessment Tool. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091158. [PMID: 36143835 PMCID: PMC9502116 DOI: 10.3390/medicina58091158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022]
Abstract
Background and Objectives: Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal conditions in children. If not treated, it leads to disability, gait abnormalities, limb shortening, and chronic pain. Our study aims to determine the impact of multiple risk factors on the incidence of DDH and to develop an interactive risk assessment tool. Materials and Methods: We conducted a retrospective cohort study in the Outpatient Clinic for Children of the Medical University of Warsaw Hospital. The Graf classification system was used for universal ultrasonographic screening. In total, 3102 infants met the eligibility criteria. Results: The incidence of DDH in the study group was 4.45%. The incidence of DDH in the Warsaw population, Poland, during the study period was 3.73 to 5.17 (95% CI). According to the multivariate analysis, the risk factors for DDH were birth weight (OR = 2.17 (1.41−3.32)), week of delivery (OR = 1.18 (1.00−1.37)), female sex (OR = 8.16 (4.86−13.71)), breech presentation (OR = 5.92 (3.37−10.40)), physical signs of DDH (25.28 (8.77−72.83)) and positive family history in siblings (5.74 (2.68−12.31)). Our results support the recent hypothesis that preterm infants (<37 weeks) have a lower rate of DDH. Conclusions: A multivariate logistic regression predictive model was used to build the risk calculator. The DDH risk calculator will be evaluated in a prospective validation study.
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Affiliation(s)
- Łukasz Pulik
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland
- Correspondence:
| | - Katarzyna Płoszka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215 Lodz, Poland
| | - Krzysztof Romaniuk
- Department of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Aleksandra Sibilska
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland
| | - Andrzej Jedynak
- Department of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Ignacy Tołwiński
- Department of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Paulina Kumięga
- Department of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Paweł Wojtyński
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland
| | - Paweł Łęgosz
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland
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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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Li J, Zhao B, Ji H, Ding W. Application Value of Combined Diagnosis of Ultrasound, MRI, and X-Ray in Developmental Dysplasia of the Hip in Children. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:1632590. [PMID: 35115901 PMCID: PMC8791747 DOI: 10.1155/2022/1632590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/16/2021] [Accepted: 01/04/2022] [Indexed: 11/19/2022]
Abstract
Objective To explore the application value of the combined diagnosis of ultrasound, MRI, and X-ray in developmental dysplasia of the hip (DDH) in children. Methods Ninety children with suspected DDH admitted to our hospital from June 2017 to June 2020 were selected as the research objects to conduct a retrospective study. According to the age of the children, they were divided into a group with 0-6 months (group X), a group with 7-12 months (group Y), and a group older than 12 months (group Z), with 30 cases in each group. X-ray and high-frequency ultrasound were performed in all groups, and MRI examination was added to the children in groups Y and Z to compare the diagnostic value of the three imaging examinations in DDH children. Results No obvious differences in the general data and maternal risk factors were observed among the three groups (P < 0.05). The final comprehensive diagnostic results were taken as the gold standard, including 23 cases with acetabular dysplasia, 28 cases with subluxation of the femoral head, 31 cases with complete dislocation of the femoral head, and 8 non-DDH cases. The diagnostic accuracy of the three methods from high to low was MRI, high-frequency ultrasound, and X-ray, with obviously higher diagnostic accuracy of MRI than that of X-ray (P < 0.05). The ROC curves showed that the diagnostic efficacy from high to low was MRI + high-frequency ultrasound + X-ray, high-frequency ultrasound + X-ray, MRI, high-frequency ultrasound, and X-ray. Conclusion Ultrasound combined with X-ray has obvious advantages in the diagnosis of children at low months of age, while MRI has outstanding advantages in the diagnosis of children at high months of age. MRI combined with ultrasound and X-ray can significantly improve the diagnostic accuracy of DDH and provide objective data support for the clinical treatment of children.
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Affiliation(s)
- Jian Li
- Department of Ultrasonography, Binzhou Hospital of Traditional Chinese Medicine, Binzhou 256601, Shandong, China
| | - Bo Zhao
- Department of Ultrasonography, Binzhou Hospital of Traditional Chinese Medicine, Binzhou 256601, Shandong, China
| | - Honghua Ji
- Department of Ultrasonography, Binzhou Hospital of Traditional Chinese Medicine, Binzhou 256601, Shandong, China
| | - Wei Ding
- Department of Ultrasonography, People's Hospital of Rizhao, Rizhao 276826, Shandong, China
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20
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Chaibi E, Saugy CA, Samara E, Zambelli PY, Merckaert SR. Comparison of treatment outcomes of stable and unstable developmental dysplasia of the hip with the Tübingen splint. Front Pediatr 2022; 10:976367. [PMID: 36090577 PMCID: PMC9453388 DOI: 10.3389/fped.2022.976367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Tübingen splint was initially developed for the treatment of stable developmental hip dysplasia (DDH). Later on, some authors expanded its include for the treatment of unstable DDH, but there remain some controversies in the literature. This study aims to compare the outcome between stable and unstable DDH treated with a Tübingen splint. METHODS Epidemiological data and ultrasonographic data of all infants diagnosed with DDH and initially treated with a Tübingen splint at our institution between May 2017 and February 2020 were assessed retrospectively. We divided the population into stable and unstable hips using the Graf classification. Age at treatment initiation, duration of treatment, complications, and radiological outcome between 12 and 24 months were investigated. RESULTS We included a total of 45 patients (57 hips) affected by DDH treated with the Tübingen splint. Treatment has been successful in 93% of stable hips and only 40% of unstable hips. Radiological outcome at 1-year follow-up significantly correlated with initial Graf classification (p < 0.001). CONCLUSION The Tübingen splint is a safe and effective treatment for stable hips, nevertheless, for unstable hips, closed reduction, and spica cast remains the gold standard.
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Affiliation(s)
- Emmelie Chaibi
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Claire-Anne Saugy
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Eleftheria Samara
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pierre-Yves Zambelli
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sophie Rosa Merckaert
- Unit of Pediatric Orthopedics, Department of Women - Mother - Child's Care, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Caffarelli C, Santamaria F, Procaccianti M, Piro E, delle Cave V, Borrelli M, Santoro A, Grassi F, Bernasconi S, Corsello G. Developments in pediatrics in 2020: choices in allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, ortopedics, respiratory tract illnesses and rheumatology. Ital J Pediatr 2021; 47:232. [PMID: 34876198 PMCID: PMC8650733 DOI: 10.1186/s13052-021-01184-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
In this article, we describe the advances in the field of pediatrics that have been published in the Italian Journal of Pediatrics in 2020. We report progresses in understanding allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, orthopedics, respiratory tract illnesses, rheumatology in childhood.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci, 14 Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Michela Procaccianti
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci, 14 Parma, Italy
| | - Ettore Piro
- Department of Sciences for Health Promotion and Mother and Child Care ‘’G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Valeria delle Cave
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Melissa Borrelli
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Angelica Santoro
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci, 14 Parma, Italy
| | - Federica Grassi
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci, 14 Parma, Italy
| | | | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care ‘’G. D’Alessandro”, University of Palermo, Palermo, Italy
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Principles of Bracing in the Early Management of Developmental Dysplasia of the Hip. Indian J Orthop 2021; 55:1417-1427. [PMID: 34785821 PMCID: PMC8582338 DOI: 10.1007/s43465-021-00525-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/13/2021] [Indexed: 02/04/2023]
Abstract
Bracing is considered a gold standard in treating Developmental Dysplasia of the Hip (DDH) in infants under 6 months of age with reducible hips. A variety of braces are available that work on similar principles of limiting hip adduction and extension. This paper summarises the current evidence regarding bracing in DDH. Most of the literature pertains to the Pavlik harness (PH) and there are few studies for other brace types. Bracing eliminates dislocating forces from the hamstrings, the block to reduction of the psoas and improves the muscle line of pull to stabilise the hip joint. Recent studies have shown no benefit in bracing for stable dysplasia. The rates of PH treatment failure in Ortolani-positive hips have been reported to be high. Barlow positive hips have lower Graf grades and are more amenable to PH treatment. There is consensus that the earlier the diagnosis of DDH and initiation of PH treatment, the better the outcome. Failure rates due to unsuccessful reduction and AVN are higher with treatment initiated after age 4-6 months. Studies have shown no benefits of staged weaning of braces. While there is no maximum time in brace, current consensus suggests a minimum of 6 weeks. The key to successful bracing lies in education and communication with the family.
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De Pellegrin M, Damia CM, Marcucci L, Moharamzadeh D. Double Diapering Ineffectiveness in Avoiding Adduction and Extension in Newborns Hips. CHILDREN-BASEL 2021; 8:children8030179. [PMID: 33652770 PMCID: PMC7996815 DOI: 10.3390/children8030179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
Hip flexion and abduction is fundamental for developmental dysplasia of the hip (DDH) treatment. At present, double diaper treatment has been inappropriately adopted when DDH is suspected. The aim of this study was to verify whether double diapers influence a newborn’s hip position. Here, we studied 50 children (23 female; 27 male; average age 62.33 ± 20.50 days; average birth weight 3230 ± 447 g) with type I hips according to Graf. At the same time of the ultrasound (US) examination, the following hip positions were measured using a manual protractor: (1) spontaneous position, supine on the outpatient bed without a diaper; (2) spontaneous position, with a double diaper; and (3) squatting position on the caretakers’ side. Statistical analysis was performed with a t-test to compare between (1) the spontaneous position without a diaper and with double diapers; (2) the spontaneous position with double diapers as well as the squatting position on the caretakers’ side with a diaper. The comparison between the hip position without diaper and with double diapers was statistically not significant for all measurements, i.e., right hip flexion (p < 0.33), left hip flexion (p < 0.34), and right and left hip abduction (p < 0.87). The comparison between the hip position with double diapers and on the caretakers’ side was statistically significant for all measurements, i.e., right hip flexion (p < 0.001), left hip flexion (p < 0.001) and right and left hip abduction (p < 0.001). We found that the use of double diapers did not affect hip position, while the position formed on the caretaker’s side shows favorable influence.
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Affiliation(s)
- Maurizio De Pellegrin
- Pediatric Orthopedic Unit, San Raffaele Hospital (IRCCS Ospedale San Raffaele), 20132 Milan, Italy; (M.D.P.); (L.M.)
| | - Chiara Maria Damia
- Residency Program Pediatrics, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Lorenzo Marcucci
- Pediatric Orthopedic Unit, San Raffaele Hospital (IRCCS Ospedale San Raffaele), 20132 Milan, Italy; (M.D.P.); (L.M.)
| | - Desiree Moharamzadeh
- Department of Orthopedic and Traumatology, San Raffaele Hospital, 20132 Milan, Italy
- Correspondence: ; Tel.: +39-02-2643-2346
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