Developmental Dysplasia of the Hip: Prevalence and Correlation with Other Diagnoses in Physiotherapy Practice-A 5-Year Retrospective Review

Live birth prevalence of major congenital anomalies in the United Arab Emirates

Major congenital anomalies (MCAs) significantly contribute to perinatal mortality and morbidity. Globally, the United Arab Emirates has the sixth-highest prevalence rate of congenital anomalies. The lack of clear baseline prevalence data for MCAs impedes the development of interventions to alleviate this burden. This study aimed to estimate the live birth prevalence of perinatally diagnosed MCAs in a sample of the Emirati population. The analysis was based on a cohort of all singleton live births in the Mutaba'ah study. Minor anomalies were excluded and the live birth prevalence of MCAs was estimated as the number of affected births per 1000 live births. Among 4034 singleton live births, 284 neonates were diagnosed with at least one MCAs, corresponding to a live birth prevalence of 70.4/1000 live births (95% confidence interval: 62.7-78.7). Of the 284 neonates, 86% presented with single-system anomalies, while 14% displayed multi-system involvement. The circulatory system was predominately affected (21.3/1000), followed by the urinary, genital, and musculoskeletal systems. Within the circulatory system, anomalies of cardiac septa (88.6%) and great arteries (70.2%) were the most prevalent. The findings indicate a relatively high live birth prevalence of MCAs. Further studies are needed to identify risk factors and explore screening and prevention strategies.

Idiopathic Developmental Dysplasia of Hip in a Female Child with a Rare Epidermal Syndrome- A Case Report

Introduction

Developmental dysplasia of the hip (DDH) describes a spectrum of disorders affecting the neonatal hip. Trachyonychia or twenty nail dystrophy refers to thin, brittle nails with excessive longitudinal ridging affecting all twenty nails. Alopecia universalis congenita (ALUNC) is a rare anomaly affecting skin and appendages. It shows a genetic preponderance with its autosomal recessive variety being the most common and severe variety.

Case Report

We report a case showing idiopathic DDH in a female child with a rare epidermal syndrome consisting of Trachyonychia and ALUNC. The cutaneous symptoms show familial inheritance in the form of autosomal dominant inheritance.

Conclusion

This case report highlights the fact that DDH can be associated with other syndromes which require multidisciplinary evaluation and research.

Incidence, Prevalence, Risk Factors, and Clinical Treatment for Children with Developmental Dysplasia of the Hip in Saudi Arabia. A Systematic Review

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).

The importance of systematic rehabilitation over 45 years of a patient with developmental dysplasia of the hip joint (case study)

Congenital hip dysplasia is a teratogenic defect and affects 2% of the population; It arises in the fetal period and can be caused by pathological factors from both the mother and the fetus. The hallmark of congenital hip dysplasia is an undeveloped, excessively shallow acetabulum that prevents stabilization of the femoral head, resulting in hip dislocation. In recent years, there has been a shift in understanding of this musculoskeletal defect, based on early clinical and ultrasound findings, to developmental hip dysplasia, which can present as hip subluxation or dislocation. This paper presents the stages of treatment of a patient with developmental hip dysplasia over a 45-year period, the course of rehabilitation, and the effects of improvement after the use of CD34+ stem cells.

Clinical Examination Findings Can Accurately Diagnose Developmental Dysplasia of The Hip-A Large, Single-Center Cohort

BACKGROUND

Physical examination findings such as limited hip abduction (LHA), asymmetric skin creases (ASC), and a popping sensation in the hip facilitate the diagnosis of developmental dysplasia of the hip (DDH). Screening with a simple physical examination during the first weeks of infancy is important for early detection of the condition, and a wide range of medical professionals, including general practitioners, obstetricians, pediatricians, and orthopedic surgeons etc. are involved in this process. The aim of this study was to determine the correlation between easily recognizable physical examination findings such as LHA, thigh/groin ACSs, and Ortolani and Barlow tests with ultrasound findings for the diagnosis of DDH.

METHODS

This study included 968 patients undergoing routine hip ultrasonography between December 2012 and January 2015. All patients were examined by an experienced orthopedic surgeon who was not the physician who performed the ultrasound examination to exclude bias between physical examination findings and ultrasound findings. Asymmetric skin folds (thigh and groin), limited abduction, Barlow and Ortolani tests were recorded. The relationship between the physical examination findings, ultrasound findings, and developmental dysplasia was investigated.

RESULTS

Of the 968 patients, 523 were female (54%) and 445 were male. On ultrasonography examination, 117 patients were found to have DDH. The sensitivity, specificity and negative predictive values of patients who were found to have both LHA and thigh/groin ASCs in all three physical examinations were high (83.8%, 70.2%, and 96.9%, respectively) while positive predictive values were found to be low (27.8%).

CONCLUSION

Asymmetric skin creases on the thigh and groin and limited hip abduction, when evaluated together, have high sensitivity and specificity with additional high negative predictive values and could help during the initial screening process of DDH.

Enhanced Child Care: Contrast Correction for Pediatric Hip Ultrasound Using Hyperanalytic Wavelets

(1) Background: The prevention of critical situations is a key ability in medicine. Hip ultrasound for neonates is a standard procedure to prevent later critical outcomes, such as hip dysplasia. Additionally, the SARS-CoV-2 pandemic has put worldwide stress upon healthcare units, resulting often in a lack of sufficient medical personnel. This work aims to develop solutions to ease and speed up the process of coming to a correct diagnosis. (2) Methods: Traditional medical procedures are envisaged, but they are enhanced to reduce diagnosing errors due to the movements of the neonates. Echographic noise filtering and contrast correction methods are implemented the Hyperanalytic Wavelet Transform, combined with an adaptive Soft Thresholding Filter. The algorithm is tailored to infants’ structure and is tested on real ultrasounds provided by the “Victor Babes” University of Medicine and Pharmacy. Denoising and contrast correction problems are targeted. (3) Results: In available clinical cases, the noise affecting the image was reduced and the contrast was enhanced. (4) Discussion: We noticed that a significant amount of noise can be added to the image, as the patients are neonates and can hardly avoid movements. (5) Conclusions: The algorithm is personalized with no fixed reference value. Any device easing the clinical procedures of physicians has a practical medical application.

Detection of developmental dysplasia of the hip in X-ray images using deep transfer learning

Background

Developmental dysplasia of the hip (DDH) is a relatively common disorder in newborns, with a reported prevalence of 1–5 per 1000 births. It can lead to developmental abnormalities in terms of mechanical difficulties and a displacement of the joint (i.e., subluxation or dysplasia). An early diagnosis in the first few months from birth can drastically improve healing, render surgical intervention unnecessary and reduce bracing time. A pelvic X-ray inspection represents the gold standard for DDH diagnosis. Recent advances in deep learning artificial intelligence have enabled the use of many image-based medical decision-making applications. The present study employs deep transfer learning in detecting DDH in pelvic X-ray images without the need for explicit measurements.

Methods

Pelvic anteroposterior X-ray images from 354 subjects (120 DDH and 234 normal) were collected locally at two hospitals in northern Jordan. A system that accepts these images as input and classifies them as DDH or normal was developed using thirteen deep transfer learning models. Various performance metrics were evaluated in addition to the overfitting/underfitting behavior and the training times.

Results

The highest mean DDH detection accuracy was 96.3% achieved using the DarkNet53 model, although other models achieved comparable results. A common theme across all the models was the extremely high sensitivity (i.e., recall) value at the expense of specificity. The F1 score, precision, recall and specificity for DarkNet53 were 95%, 90.6%, 100% and 94.3%, respectively.

Conclusions

Our automated method appears to be a highly accurate DDH screening and diagnosis method. Moreover, the performance evaluation shows that it is possible to further improve the system by expanding the dataset to include more X-ray images.