Ultrasonography of Borderline and Asymmetric Infant Hips - a Challenge in the Management of Developmental Dysplasia of the Hip

Background and aim. Developmental dysplasia of the hip (DDH) is a potentially disabling disease. There are many diagnostic approaches, Graf method ultrasonography being the most popular imaging method. Although considered as a healthy condition, the existence of hips at the 60 degree limit or the asymmetries higher than 4 degrees between left and right side may be a source of unfavorable evolution and consequently of late diagnosed dysplasia cases.Methods. The retrospective study was conducted in the Radiology Department of the Emergency Clinical County Hospital Cluj-Napoca, by retrospective analysis of the database containing 3013 records of the subjects presented for DDH assessment between January 2008 and December 2014. The study focuses on investigating two possible sources of missed cases by clinical-ultrasound management of DDH: borderline and asymmetric hips. Two conditions were studied in patients considered healthy according to Graf method: borderline hips (those with α angle value of 60° and 61°) and asymmetric hips (left to right difference between the α angle values exceeds 4°). Three study groups were formed: healthy subjects, asymmetric/borderline subjects and patients with immature or mild dysplasia. The incidence of risk factors, clinical suspicion and the success of therapy were evaluated. Results. There were no significant differences between the three groups regarding the role of the risk factors in DDH pathogenesis. Data reveal a high suspicion rate after the clinical examination, in groups II and III, compared to the healthy population. This means that from this point of view, Group II might be considered having at least a dysplastic prognosis. An increased correlation in the therapeutic results was observed between Group II patients and those from mild delayed maturation subgroups from Group III (IIa-, IIa+).Conclusions. Asymmetric and borderline hips should be approached similarly to immature hips, clinical suspicion and the therapeutic outcome being similar.

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Early detection of developmental dysplasia of hip by ultrasound

Hip International ◽

10.1177/1120700019879687 ◽

2019 ◽

pp. 112070001987968 ◽

Cited By ~ 1

Author(s):

Zita Gyurkovits ◽

Gellért Sohár ◽

Anna Baricsa ◽

Gábor Németh ◽

Hajnalka Orvos ◽

...

Keyword(s):

Risk Factors ◽

Positive Family History ◽

Breech Presentation ◽

Female Gender ◽

Developmental Dysplasia ◽

Developmental Dysplasia Of Hip ◽

Graf Method ◽

Hip Ultrasound ◽

A Prospective Study ◽

Dysplasia Of The Hip

Objective: To assess the effectiveness of early universal ultrasound (US) screening of developmental dysplasia of the hip (DDH). Study design: A prospective study of universal hip screening of all mature neonates was conducted from 2012 to 2013, at the Department of Obstetrics and Gynaecology, University of Szeged; 1636 newborns (3272 hips) had clinical examinations and hip ultrasound by the Graf method within the1st 3 days of life. Prevalence of DDH, risk factors, sensitivity and specificity of clinical examinations were evaluated. Results: At the 1st US, 70 of the examined 3272 hips (2.14%) were found to be positive. According to Graf categories, the following distribution was observed: type II C, 21 hips (30.0%); D, 24 hips (34.28%); III, 24 hips (34.28%); IV, 1 hip (1.44%). Regarding the risk factors, female gender, breech presentation and positive family history proved to be significant. Interestingly, 28 (50.90%) of the 55 newborns with DDH had neither positive physical signs nor any risk factors, except being female. The physical examination was calculated for sensitivity (20.0%) and specificity (98.34%). Conclusions: In our 1-year period study, 50.9% of the newborns with DDH had neither any positive physical signs nor any risk factors, except being a female. In contrast, early universal US screening of the hip facilitated to diagnose all cases with hip dysplasia. Hip sonography is an effective mode of prevention in orthopaedics, however further studies are needed to compare the rates of operative procedures in selective versus universal screening models.

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Assessment of Variations in the Measurement of Hip Ultrasonography by the Graf Method in Developmental Dysplasia of the Hip§

Journal of Pediatric Orthopaedics B ◽

10.1097/01202412-200110020-00002 ◽

2001 ◽

Vol 10 (2) ◽

pp. 89-95 ◽

Cited By ~ 26

Author(s):

Hakan Ömeroğlu ◽

Ali Biçmoǧlu ◽

Süha Koparal ◽

Sinan Seber

Keyword(s):

Developmental Dysplasia ◽

Graf Method ◽

Dysplasia Of The Hip ◽

Hip Ultrasonography

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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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Risk Factor Assessment and a Ten-Year Experience of DDH Screening in a Well-Child Population

BioMed Research International ◽

10.1155/2019/7213681 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Bahar Kural ◽

Esra Devecioğlu Karapınar ◽

Pınar Yılmazbaş ◽

Tijen Eren ◽

Gülbin Gökçay

Keyword(s):

Risk Factors ◽

Multiple Pregnancy ◽

Breech Presentation ◽

Clinical Findings ◽

Developmental Dysplasia ◽

Control Group ◽

Case Group ◽

Retrospective Case ◽

Female Sex ◽

Dysplasia Of The Hip

Aim. Risk based screening for developmental dysplasia of the hip (DDH) with ultrasound is common. However, risk factors vary from one country to the other since data are insufficient to give clear recommendations. We aimed to evaluate the risk factors for developmental dysplasia of the hip (DDH). Methods. In this retrospective case-control study, the health records of all children, who were followed up between 2004 and 2014 at a well-child unit, were investigated for the diagnosis of DDH in Turkey. Of 9758 children, 57 children were found to have abnormal ultrasonographic findings (according to Graf classification) and these constituted the case group. As the control group, healthy 228 children who matched the case children in birth months were selected. Two groups were compared for the risk factors. Results. A total of 19516 hips of 9758 children were examined for DDH. 97 hips of 57 children were found to have abnormal ultrasonographic findings. When the two groups were compared, breech presentation, multiple pregnancy, and torticollis were identified as risk factors. The female sex was also found to have a significantly high prevalence among the children in the case group. Limited hip abduction, positive Ortolani, and Barlow signs were important clinical findings in the case group. Conclusion. According to our findings, breech presentation, female sex, torticollis, and multiple pregnancy were found to be the risk factors of this disorder. Infants with these risk factors should be investigated carefully for DDH.

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Associations between risk factors and developmental dysplasia of the hip and ultrasonographic hip type: a retrospective case control study

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.180174 ◽

2019 ◽

Vol 13 (2) ◽

pp. 161-166 ◽

Cited By ~ 5

Author(s):

H. Ömeroğlu ◽

A. Akceylan ◽

N. Köse

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Family History ◽

Hip Dysplasia ◽

Positive Family History ◽

Significant Risk ◽

Breech Presentation ◽

Developmental Dysplasia ◽

Type I ◽

Dysplasia Of The Hip

Purpose We aimed to revisit the correlation between the previously defined risk factors and the occurrence of developmental dysplasia of the hip (DDH) and to assess the influence of these factors on the ultrasonographic type of hip dysplasia according to the Graf’s classification in patients with DDH. Methods Data of healthy infants (mean age 33 days) who had bilateral mature (normal) hips (Graf type I) were compared with the data of infants (mean age 105 days) who were treated by abduction brace due to unilateral or bilateral DDH (Graf type IIa- and worse hips). Results Infants with at least one risk factor had a significantly higher rate of DDH than those with no risk factors (p < 0.001). Likewise, infants with more than one risk factor had a significantly higher rate of DDH than those with only one risk factor (p = 0.008). Family history, breech presentation and swaddling were found to be the three significant risk factors related to the development of DDH. Family history, swaddling and oligohydramnios were found to be the three significant risk factors correlated with a higher rate of unstable/decentred hip(s) (Graf types D/III/IV) in patients with DDH. Conclusion The risk of DDH significantly increases in infants who have more than one risk factor for DDH. Positive family history and postnatal traditional swaddling are the two main factors both in the aetiology of DDH and in development of a more severe hip dysplasia in patients with DDH. Besides, breech presentation increases the risk of development of DDH and oligohydramnios leads to development of a more severe hip dysplasia in patients with DDH. By introducing these four variables as ‘absolute risk factors for DDH’ to the selective newborn hip screening programmes, the sensitivity and specificity of these programmes may be optimized and the risk of delayed diagnosis may be lessened. Level of Evidence Level III prognostic study

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Socioeconomic Risk Factors for Poor Outcomes of Developmental Dysplasia of the Hip

The Journal of Pediatrics ◽

10.1016/j.jpeds.2019.04.029 ◽

2019 ◽

Vol 211 ◽

pp. 159-163 ◽

Cited By ~ 1

Author(s):

Rajan R. Murgai ◽

Liam R. Harris ◽

Paul D. Choi ◽

Rachel Y. Goldstein

Keyword(s):

Risk Factors ◽

Developmental Dysplasia ◽

Poor Outcomes ◽

Socioeconomic Risk ◽

Dysplasia Of The Hip ◽

Socioeconomic Risk Factors

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Risk factors for Developmental Dysplasia of the Hip: Ultrasonographic Findings in the Neonatal Period

Journal of Pediatric Orthopaedics B ◽

10.1097/01202412-200207000-00004 ◽

2002 ◽

Vol 11 (3) ◽

pp. 212-218 ◽

Cited By ~ 1

Author(s):

Christopher E. Bache ◽

John Clegg ◽

Mark Herron

Keyword(s):

Risk Factors ◽

Neonatal Period ◽

Developmental Dysplasia ◽

Dysplasia Of The Hip

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The positive predictive value of asymmetrical skin creases in the diagnosis of pathological developmental dysplasia of the hip

The Bone & Joint Journal ◽

10.1302/0301-620x.100b5.bjj-2017-0994.r2 ◽

2018 ◽

Vol 100-B (5) ◽

pp. 675-679 ◽

Cited By ~ 8

Author(s):

M. J. Anderton ◽

G. R. Hastie ◽

R. W. Paton

Keyword(s):

Risk Factors ◽

Positive Predictive Value ◽

Predictive Value ◽

Clinical Signs ◽

Senior Author ◽

Developmental Dysplasia ◽

Inclusion Criteria ◽

Leg Length ◽

One Stop ◽

Dysplasia Of The Hip

Aims The aim of this study was to identify the association between asymmetrical skin creases of the thigh, buttock or inguinal region and pathological developmental dysplasia of the hip (DDH). Patients and Methods Between 1 January 1996 and 31 December 2016, all patients referred to our unit from primary or secondary care with risk factors for DDH were assessed in a “one stop” clinic. All had clinical and sonographic assessment by the senior author (RWP) with the results being recorded prospectively. The inclusion criteria for this study were babies and children referred with asymmetrical skin creases. Those with a neurological cause of DDH were excluded. The positive predictive value (PPV) for pathological DDH was calculated. Results A total of 105 patients met the inclusion criteria. There were 71 girls and 34 boys. Only two were found to have pathological DDH. Both also had unilateral limited abduction of the hip in flexion and a positive Galeazzi sign with apparent leg-length discrepancy. Thus, if the specialist examination of a patient with asymmetrical skin creases was normal, the PPV for DDH was 0%. Conclusion Isolated asymmetrical skin creases are an unreliable clinical sign in the diagnosis of pathological DDH. Greater emphasis should be placed on the presence of additional clinical signs to guide radiological screening in babies and children. Cite this article: Bone Joint J 2018;100-B:675–9.

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