Description of the ‘pronation manoeuvre’ for the diagnosis of developmental hip dysplasia

Abstract Introduction Without a prompt diagnosis, developmental dysplasia of the hip (DDH) in infants can lead to severe sequelae. Current screening strategies emphasize the use of Ortolani and Barlow physical examination manoeuvres, yet they exhibit low sensitivity. The purpose of this study is to evaluate the performance of a new physical examination tool (the pronation manoeuvre) as a screening tool for DDH. Methods To evaluate the new manoeuvre, a cross-sectional and analytic study was performed with a nonprobabilistic sampling method. Patients with either a positive Ortolani or Barlow manoeuver were evaluated with the new manoeuvre and hip ultrasound. Controls were infants with negative Ortolani, Barlow and pronation manoeuvres and also had ultrasound performed. Results DDH was confirmed in 83 of 130 cases (64%) and 2 of 130 controls (2%). The new pronation manoeuvre had a sensitivity of 76% and a specificity of 94% as compared to the Ortolani and Barlow manoeuvres (sensitivity 31 to 32%, specificity 93 to 100%) (P<0.05). Conclusion This new physical examination manoeuvre could serve as another clinical tool for the initial screening of DDH in newborns. Its promising results against traditional screening procedures might potentially impact diagnosis and prognosis for patients with DDH.

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Prevalence of Hip Ultrasound Abnormalities in Newborns With a Hip Click

Clinical Pediatrics ◽

10.1177/0009922820920011 ◽

2020 ◽

Vol 59 (8) ◽

pp. 773-777

Author(s):

John T. Gaffney ◽

John Spellman

Keyword(s):

Family History ◽

Confidence Interval ◽

Physical Examination ◽

Prospective Studies ◽

Hip Dysplasia ◽

Developmental Dysplasia ◽

Inclusion Criteria ◽

History Of ◽

Hip Ultrasound ◽

Dysplasia Of The Hip

A hip click on examination of the newborn hip is believed to be the result of a ligament or myofascial structure and thought to be benign. Some studies suggest a link between hip clicks and developmental dysplasia of the hip. The purpose of our study is to estimate the prevalence of ultrasound hip abnormalities in newborns with a hip click and an otherwise normal physical examination. Results. Ninety patients meeting inclusion criteria of a hip click with an otherwise normal physical examination underwent diagnostic ultrasound with a 17.8% prevalence of hip abnormalities found (95% confidence interval ±7.9% [range of 9.9% to 25.7%]). Our study had 64 (71%) females and 26 (29%) males. The prevalence of hip pathology for females was 18.8% (12 of 64 patients) and for males was 15.4% (4 of 26 patients). Thirty-three patients were found to have bilateral hip clicks on presentation, with 21.2% (7 of 33) of those patients found to have hip pathology on ultrasound (3 of the 7 had pathology of both hips). Six patients had a family history of hip dysplasia and 1 of these patients (16.7%) had pathology on ultrasound. The average age to hip sonography was 6.6 weeks. Conclusions. In all, 17.8% of newborns with a hip click were found to have hip abnormalities on ultrasound. The prevalence of hip pathology, on ultrasound, suggests that additional larger, prospective studies are needed to clarify the association between a hip click and abnormal ultrasound found at 6 weeks of age or greater.

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Developmental dysplasia of the hip

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0223 ◽

2020 ◽

Vol 81 (7) ◽

pp. 1-8

Author(s):

Stella Zhang ◽

Konstantinos J Doudoulakis ◽

Anita Khurwal ◽

Khaled M Sarraf

Keyword(s):

Femoral Head ◽

Physical Examination ◽

Screening Programme ◽

Developmental Dysplasia ◽

Monitoring Tool ◽

Newborn Screening Programme ◽

Hip Stability ◽

Hip Ultrasound ◽

The Uk ◽

Dysplasia Of The Hip

Developmental dysplasia of the hip encompasses a range of hip abnormalities in which the femoral head and acetabulum fail to develop and articulate anatomically. Developmental dysplasia of the hip is a clinically important condition, with a prevalence of 1–2/1000 in unscreened populations and 5–30/1000 in clinically screened populations. The pathology is incongruence between the femoral head and the acetabulum, which can be caused by an abnormally shaped femoral head, acetabulum, or both. This results in a spectrum of different hip abnormalities. The precise aetiology behind developmental dysplasia of the hip is unclear, but there are a number of established risk factors. In the UK, universal clinical examination of newborns and 6–8-week-old babies is performed under the national UK newborn screening programme for developmental dysplasia of the hip (part of the Newborn and Infant Physical Examination). The physical examination of the newborn hip involves initial inspection of the infant for any of the clinical features of developmental dysplasia of the hip, followed by hip stability tests (Barlow's and Ortolani's tests). Hip ultrasound is the gold standard diagnostic and monitoring tool for developmental dysplasia of the hip in newborns and infants under 6 months of age, or until ossification of the femoral head. Some mild cases of developmental dysplasia of the hip (and the immature hip) resolve without requiring intervention; however, there are a number of treatments, both non-operative and operative, that may be used at various stages of this condition.

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Prediction of the requirement of open reduction for developmental dysplasia of the hip

Journal of International Medical Research ◽

10.1177/0300060517717357 ◽

2017 ◽

Vol 46 (1) ◽

pp. 54-61 ◽

Cited By ~ 8

Author(s):

Nabil Alassaf

Keyword(s):

Open Reduction ◽

Area Under The Curve ◽

Internal Validity ◽

Developmental Dysplasia ◽

Estimation Model ◽

Cross Sectional ◽

Noninvasive Treatment ◽

Dysplasia Of The Hip ◽

Logistic Regression Equation ◽

Objective Tool

Objective Closed reduction (CR) is a noninvasive treatment for developmental dysplasia of the hip (DDH), and this treatment is confirmed intraoperatively. This study aimed to develop a preoperative estimation model of the probability of requiring open reduction (OR) for DDH. Methods The study design was cross-sectional by screening all patients younger than 2 years who had attempted CR between October 2012 and July 2016 by a single surgeon. Potential diagnostic determinants were sex, age, side, bilaterality, International Hip Dysplasia Institute (IHDI) grade, and acetabular index (AI). An intraoperative arthrogram was the reference standard. A logistic regression equation was built from a reduced model. Bootstrapping was performed for internal validity. Results A total of 164 hips in 104 patients who met the inclusion criteria were analysed. The prevalence of CR was 72.2%. Independent factors for OR were older age, higher IHDI grade, and lower AI. The probability of OR = 1/[1 + exp − (−2.753 + 0.112 × age (months) + 1.965 × IHDI grade III (0 or 1) + 3.515 × IHDI grade IV (0 or 1) − 0.058 × AI (degrees)]. The area under the curve was 0.79. Conclusion This equation is an objective tool that can be used to estimate the requirement for OR.

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Developmental Hip Dysplasia

Musculoskeletal Imaging Volume 2 ◽

10.1093/med/9780190938178.003.0113 ◽

2019 ◽

pp. 297-300

Author(s):

Dorothy L. Gilbertson-Dahdal

Keyword(s):

Risk Factors ◽

Problem Solving ◽

Imaging Modality ◽

Treatment Options ◽

Hip Dislocation ◽

Clinical Findings ◽

Developmental Dysplasia ◽

Developmental Hip Dysplasia ◽

Hormonal Factors ◽

Dysplasia Of The Hip

Chapter 112 focuses on developmental dysplasia of the hip, which includes a spectrum of abnormalities ranging from a stable hip with a mildly dysplastic acetabulum to complete hip dislocation. Pathophysiology, clinical findings, and screening studies are explored. The pathophysiology is multifactorial including mechanical, genetic and hormonal factors. Imaging strategies, findings, and treatment options are also discussed. Screening US, which is the imaging modality of choice, is performed on infants with predisposing risk factors. Outcome is quite variable with many cases resolving spontaneously without treatment whereas others stabilize with acetabular dysplasia. Treatment options include immobilization and surgery. MRI is used for problem solving in postoperative patients.

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Physical examination

Health for all Children ◽

10.1093/med/9780198570844.003.0007 ◽

2006 ◽

pp. 142-163

Author(s):

David M. B. Hall ◽

David Elliman

Keyword(s):

Heart Disease ◽

Hypertrophic Cardiomyopathy ◽

Physical Examination ◽

Developmental Dysplasia ◽

Congenital Dislocation ◽

Undescended Testes ◽

Dysplasia Of The Hip ◽

Dislocation Of The Hip

Chapter 7 covers the neonatal and 6–8 week examinations, the school entrant examination, and screening by physical examination for developmental dysplasia of the hip (DDH) (previously known as congenital dislocation of the hip), heart disease including hypertrophic cardiomyopathy (HCM), hypertension, asthma, and undescended testes and other genital abnormalities.

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Developmental dysplasia of the hip: update of management

EFORT Open Reviews ◽

10.1302/2058-5241.4.180019 ◽

2019 ◽

Vol 4 (9) ◽

pp. 548-556 ◽

Cited By ~ 7

Author(s):

Alfonso Vaquero-Picado ◽

Gaspar González-Morán ◽

Enrique Gil Garay ◽

Luis Moraleda

Keyword(s):

Physical Examination ◽

Open Reduction ◽

Acetabular Dysplasia ◽

Wide Spectrum ◽

Positive Family History ◽

Developmental Dysplasia ◽

Ultrasound Screening ◽

Spontaneous Correction ◽

Hip Reduction ◽

Dysplasia Of The Hip

The term ‘developmental dysplasia of the hip’ (DDH) includes a wide spectrum of hip alterations: neonatal instability; acetabular dysplasia; hip subluxation; and true dislocation of the hip. DDH alters hip biomechanics, overloading the articular cartilage and leading to early osteoarthritis. DDH is the main cause of total hip replacement in young people (about 21% to 29%). Development of the acetabular cavity is determined by the presence of a concentrically reduced femoral head. Hip subluxation or dislocation in a child will cause an inadequate development of the acetabulum during the remaining growth. Clinical screening (instability manoeuvres) should be done universally as a part of the physical examination of the newborn. After two or three months of life, limited hip abduction is the most important clinical sign. Selective ultrasound screening should be performed in any child with abnormal physical examination or in those with high-risk factors (breech presentation and positive family history). Universal ultrasound screening has not demonstrated its utility in diminishing the incidence of late dysplasia. Almost 90% of patients with mild hip instability at birth are resolved spontaneously within the first eight weeks and 96% of pathologic changes observed in echography are resolved spontaneously within the first six weeks of life. However, an Ortolani-positive hip requires immediate treatment. When the hip is dislocated or subluxated, a concentric and stable reduction without forceful abduction needs to be obtained by closed or open means. Pavlik harness is usually the first line of treatment under the age of six months. Hip arthrogram is useful for guiding the decision of performing a closed or open reduction when needed. Acetabular dysplasia improves in the majority due to the stimulus provoked by hip reduction. The best parameter to predict persistent acetabular dysplasia at maturity is the evolution of the acetabular index. Pelvic or femoral osteotomies should be performed when residual acetabular dysplasia is present or in older children when a spontaneous correction after hip reduction is not expected. Avascular necrosis is the most serious complication and is related to: an excessive abduction of the hip; a force closed reduction when obstacles for reduction are present; a maintained dislocated hip within the harness or spica cast; and a surgical open reduction.Cite this article: EFORT Open Rev 2019;4:548-556. DOI: 10.1302/2058-5241.4.180019

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Risk Factors for Developmental Dysplasia of the Hip in Newborns from Celaya, Guanajuato, Mexico: A Cross Sectional Study

British Journal of Medicine and Medical Research ◽

10.9734/bjmmr/2016/23125 ◽

2016 ◽

Vol 12 (10) ◽

pp. 1-7

Author(s):

Carolina Mendoza-Lara ◽

Nicolas Padilla-Raygoza ◽

Georgina Olvera-Villanueva ◽

Silvia Delgado-Sandoval

Keyword(s):

Risk Factors ◽

Cross Sectional Study ◽

Developmental Dysplasia ◽

Sectional Study ◽

Cross Sectional ◽

Dysplasia Of The Hip

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Developmental hip dysplasia in adolescence

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0908440v ◽

2009 ◽

Vol 137 (7-8) ◽

pp. 440-443 ◽

Cited By ~ 3

Author(s):

Zoran Vukasinovic ◽

Zorica Zivkovic ◽

Cedomir Vucetic

Keyword(s):

Hip Dysplasia ◽

Developmental Dysplasia ◽

Pathological Findings ◽

Leg Length ◽

Treatment Results ◽

Developmental Hip Dysplasia ◽

Treatment Protocols ◽

Management Modes ◽

Dysplasia Of The Hip

The authors define adolescence and developmental dysplasia of the hip (DDH). Special attention is paid to pathological findings characteristic of DDH in adolescence (unrecognized and untreated DDH; treated DDH, but non-terminated treatment; DDH diagnosed with delay, inadequately treated, with complications). The authors emphasise that DDH treatment has to be successfully terminated well before the adolescence; possibilities are explained on management modes at the time of adolescence, and possible persons guilty for the persistence of later hip problems are indicated. Based on the authors' experience and having in mind all surgical possibilities for the treatment (pelvic osteotomies, femoral osteotomies, trochanteroplasties, leg length equalization procedures) the authors propose treatment protocols. The intention is to provide better treatment results and to prevent secondary hip arthrosis. Furthermore, how to improve the struggle against DDH is suggested.

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Developmental dysplasia of the hip - clinical management and ultrasound screening

Morecambe Bay Medical Journal ◽

10.48037/mbmj.v3i10.660 ◽

2001 ◽

Vol 3 (10) ◽

pp. 324-328

Author(s):

P Marshall ◽

S Wildon

Keyword(s):

Hospital Care ◽

Hip Dysplasia ◽

Screening Programme ◽

Developmental Dysplasia ◽

Ultrasound Screening ◽

National Guidelines ◽

Developmental Hip Dysplasia ◽

Clinical Screening ◽

Health Visitors ◽

Dysplasia Of The Hip

Although there is an agreed national protocol for the clinical screening of developmental hip dysplasia (DDH) there are no national guidelines for the use of ultrasound to detect this condition. The increased incidence of babies requiring surgery for this condition across the bay has led us to institute a selective screening programme in line with best clinical practice. This article describes care pathways in primary and hospital care in some detail and will therefore be of direct clinical relevance to the midwive , health visitors, general practitioners, physiotherapists, paediatricians, and orthopaedic surgeons involved in the management of babies at higher risk of DDH. We also outline the physiotherapy and orthopaedic management of children with this condition. Feedback or suggestions relating to the recently introduced screening programme would be welcomed.

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