Aims. Early detection of developmental dysplasia of the hip (DDH) is associated with improved outcomes of conservative treatment. Therefore, we aimed to evaluate a novel screening programme that included both the primary risk factors of breech presentation and family history, and the secondary risk factors of oligohydramnios and foot deformities. Methods. A five-year prospective registry study investigating every live birth in the study’s catchment area (n = 27,731), all of whom underwent screening for risk factors and examination at the newborn and six- to eight-week neonatal examination and review. DDH was diagnosed using ultrasonography and the
Introduction. There is little evidence surrounding the clinical implications of a diagnosis of IIa hip dysplasia with no consensus as to its efficacy as a predictor pathological dysplasia or treatment. Therefore, we evaluated the importance of categorising 2a hip dysplasia in to 2a- and 2a+ to better understand the clinical outcomes of each. Methods. A 9-year retrospective cohort study of patients with a diagnosis of type IIa hip dysplasia between 2011 – 2020 (n=341) in our centre. Ultrasound scans were graded using
Reduction therapy in developmental dysplasia of the hip (DDH) is initialized in the newborn period. Harness treatment is continued until normal ultrasound-values are reached. Above the age of one year the assessment of DDH relies mainly on interpretation of plain radiographs of the pelvis. In order to rule out residual dysplasia after ultrasound controlled treatment radiological control is advised to the time children start walking. The purpose of this study is to evaluate the early radiological outcome after ultrasound controlled treatment of DDH and to examine whether there is a correlation between the initial severitiy of DDH, measured by ultrasound, and the severity of residual DDH on the radiograph at the time of the first follow-up. A. p. pelvic radiographs of 90 children (72 girls, 18 boys, 180 hips) with DDH (29 unilateral, 61 bilateral) were reviewed retrospectively. To the beginning of the ultrasound surveilled therapy (mean age 7,2 weeks) the morphologic findings were staged according to the
Purpose. This 20-year prospective longitudinal observational study aims to determine the incidence of pathological developmental dysplasia of the hip (DDH) in children referred with clicky hips and define the risk posed to inform neonatal hip screening programmes including the role of ultrasound. Method. 355 children from 1997 to 2016 were referred with clicky hips to our “one stop” paediatric hip clinic under the local neonatal hip screening programme. Hips were assessed clinically for instability and by ultrasound using a simplified
The present study seeks to investigate the correlation of pubofemoral distances (PFD) to α angles, and hip displaceability status, defined as femoral head coverage (FHC) or FHC during manual provocation of the newborn hip < 50%. We retrospectively included all newborns referred for ultrasound screening at our institution based on primary risk factor, clinical, and PFD screening. α angles, PFD, FHC, and FHC at follow-up ultrasound for referred newborns were measured and compared using scatter plots, linear regression, paired Aims
Methods
Ultrasound (US) is the standard imaging modality used to screen for developmental dysplasia of the hip in infants. Currently, radiologists or orthopaedic surgeons review scan images and judge them to be adequate or inadequate for interpretation. If considered adequate, diagnostic dysplasia metrics are determined; however, there is no standardised method for this process. There is significant inter-observer variability in this manual process which can affect misdiagnosis rates. To eliminate this subjectivity, we developed an automatic method to identify adequate US images and extract dysplasia metrics. The purpose of this study was to validate the efficacy of this automatic method by comparing results with observer-determined dysplasia metrics on a set of US images. A total of 693 US images from scans of 35 infants were analysed. Trained clinicians at a single institution labeled each image as adequate or inadequate, and subsequently measured alpha and beta angles on adequate images to diagnose dysplasia. We trained our image classifier on random sets of 415 images and used it to assess the remaining 278 images. Alpha and beta angles were automatically estimated on all adequate images. We compared the manual and automatic methods for discrepancies in adequacy determination, metric variability and incidences of missed early diagnosis or over-treatment. There was excellent agreement between the automatic and manual methods in image adequacy classification (Kappa coefficient = 0.912). On each adequate US image, alpha and beta angle measurements were compared, producing mixed levels of agreement between methods. Mean discrepancies of 1.78°±4.72° and 8.91°±6.437° were seen for alpha and beta angles, respectively. Standard deviations of the angle measures across multiple images from a single patient scan were significantly reduced by the automatic method for both alpha (p<0.05) and beta (p<0.01) angles. Additionally, the automatic method classified three hips (two patients) as Graf type II and two hips (two patients) as type III, while the manual method classified them as type I and II, respectively. Both cases flagged as type III patients by the automatic system subsequently failed Pavlik harness treatment and were booked for surgery. The automatic method produced excellent agreement with radiologists in scan adequacy classification and significantly reduced measurement variability. Good agreement between methods was found in
Purpose of study: Recent literature suggests the mode of delivery; either normal vaginal delivery (NVD) or caesarean section (LSCS) influences the incidence of DDH for term breech infants. This study examines whether the incidence of DDH amongst term breech infants is related to the mode of delivery. Methods: All term infants born breech between 1. st. April 1995 and 31. st. March 2002 were included. All infants who presented breech were screened by ultrasound as part of an ongoing longitudinal cohort study. Data regarding mode of delivery, either NVD or LSCS elective or LSCS emergency was obtained from hospital records. DDH is a spectrum from minor dysplasia to dislocated irreducible hips. DDH was recorded according to the modified
This study shows the efficacy of The Pavlik harness for the treatment of Development Dysplasia of Hip using ultrasonographic monitoring. Between March 1995 and February 2000 we treated 149 dysplastic hips in 117 babies. According to the
Introduction: Ideally any screening system should use a simple reliable test with good intraobserver reproducibility. This is important in DDH as once there is an established abnormality surgical intervention is frequently required. The aim of early detection (within six weeks) is to increase the number of children that may be treated nonoperatively. We have evaluated the effectiveness of our selective screening program by determining the late presentation rate of DDH in our region. Methods: Between January 2001 and December 2003 we looked retrospectively at all patients presenting with DDH in our region. We recorded their age at scan and presentation, the
Introduction: 1986 we started with ultrasound screening for congenital dislocation of the hip (CDH) in all newborn children from our hospital. In 1995 an regime was investigated we developed out of our expieriences of the previous years and started a prospective study. Material and methods: In the period 1995 to 2006 we did ultrasound screening in newborn babies within the first week of life. There were 14744 ultrasound checkups in 7372 children. Following the
Developmental dysplasia of the hip (DDH) can be managed effectively with non-surgical interventions when diagnosed early. However, the likelihood of surgical intervention increases with a late presentation. Therefore, an effective screening programme is essential to prevent late diagnosis and reduce surgical morbidity in the population. We conducted a systematic review and meta-analysis of the epidemiological literature from the last 25 years in the UK. Articles were selected from databases searches using MEDLINE, EMBASE, OVID, and Cochrane; 13 papers met the inclusion criteria.Aims
Methods
To determine the likelihood of achieving a successful closed reduction (CR) of a dislocated hip in developmental dysplasia of the hip (DDH) after failed Pavlik harness treatment We report the rate of avascular necrosis (AVN) and the need for further surgical procedures. Data was obtained from the Northern Ireland DDH database. All children who underwent an attempted closed reduction between 2011 and 2016 were identified. Children with a dislocated hip that failed Pavlik harness treatment were included in the study. Successful closed reduction was defined as a hip that reduced in theatre and remained reduced. Most recent imaging was assessed for the presence of AVN using the Kalamchi and MacEwen classification.Aims
Methods
There is a very long way from diagnosis to treatment of the developmental dysplasia of the hip. Everything is complex: clinical examination is subtle and requires a long training. Treatment is not as simple as could be thought. The risks include approximate examinations and of standard, ready-made ones. The discussion has not been settled as to whether all children with hip instability can be clinically detected at birth. The complexity of the problem arises from the fact that only 10% of children who have instability at birth develop long-term problems if they are left untreated. It is well known, affirmed by several different studies that at birth the incidence of hip instability in approximately 1–4% of patients, with figure being higher in girls. There is also a consensus that a large majority of these unstable hips will become stable during the first few days of life, even without treatment. What is not known, however, is how many of those hip that become stable will become completely normal as the child grows. These two fundamental issues are of the utmost importance. They emphasize the significance of early examination (first 48 hours) in order to detect instability and employ careful follow-up of any newborn in whom hip instability has been identified. Some children are at particular risk of hip instability. Those infants are labeled as “high risk”. They include children born in families with hip instability, those presented by breech, first born children or products of oligohydramniotic pregnancies, particularly girls, those with the generalized joint laxity, those with torticollis and scoliosis, those with foot deformities and increased birth-weight over 4000g. Whilst all children should be screened at birth by a doctor experienced in clinical examination with particular attention directed to those children, who are considered high risk. It must be emphasized that clinical examination is the most important for the detection of hip instability in newborns. Clinical examination should be very delicate, gentle, based on feelings rather than signs. Clinically, hip instability can be divided into: 1. irreducible dislocation, 2. reducible dislocation, 3. dislocatability, 4. subluxability. The clinical tests of instability were described by Ortolani and Barlow. Fully dislocated irreducible hip is a very rare condition and may be associated with neuromuscular abnormality. It represents dislocation well before delivery. In this form acetabulum is vacant, femoral head palpable posteriorly. There are no singns of Ortolani and Barlow tests. We can only find the sings of “pump”, which means there exists a movement along the long axis of the leg. This is the most severe pathology of the hip in DDH.The reducible dislocation is characterized by the Ortolani maneuver. With the hip flexed 90 degrees, we abduct the hip and than we feel and hear the click which is the sign of the reduction of the hip. Dislocatable and subluxatable are the most common types of pathology of the hip in DDH. This deformity arises at the end of pregnancy. This is characterized by positive Barlow test, which is the provoked-dislocation test. Using it we can dislocate or subluxate the hip. It is very rare to find restricted hip movements in newborns. The limited abduction of the affected hip is the sign typical for older children, more the 3 months of age. It is crucial to repeat the clinical examination even during the same office visit. Ultrasonography has changed our diagnostic ability for DDH. These direct examinations help us in hip evaluation in the first days of the newborn period. The exact
Aim. The aim of this study is to assess the effectiveness of clinic based ultrasound screening by Orthopaedic surgeon for early diagnosis and treatment of developmental dysplasia of hip (DDH) in one stop clinic. Methods. This prospective study included 395 infants (185 male and 210 female) (5.2% of study population) who were referred for screening on the basis of abnormal findings or the presence of risk factors for DDH. Average age was 12.5 weeks (1 day to 15 months). All infants were assessed for risk factors of DDH. Clinical examinations were performed by the senior author followed by ultrasonography of both of the infant's hips, using the Graf's technique. Alpha and beta angles were calculated and hips were classified according to
Introduction: Late diagnosed developmental dysplasia of the hip joint (DDH) is now a very rare case in an orthopaedic practice. It is mostly because of early ultrasound screenings of baby’s hips. Two ultrasound techniques are most popular and widely used in the world – the Graf’s technique in Europe and Harcke’s in the USA. The purpose of this study was to establish a value of Harcke’s technique which is not very popular in Europe. Material and Methods: During the last 10 years, 25 000 ultrasound hip examinations of newborns hips because of early DDH screening were performed in our Clinic. In every child both hips were examined using two techniques (Graf’s and Harcke’s). The mean age during the first hip ultrasound examination was 5 weeks (from 10 days to 8 weeks). The Siemens SL1 equipment with linear transducer of 7.5 MHz was used for examination. The position of the hip during examination followed all requirements indicated by Graf or Harcke. All ultrasound examination were performed and analyzed by two orthopaedic surgeons. Results: In this study the DDH was diagnosed in 5,6% of all examined hips. Most common type of dysplastic hip was type II according to
The D.D.H screening programme until the second half of ’80 was based on the clinical Ortolani-Barlow’s manoeuvre at newborn age and by xray examination of the pelvis at three – four month old to discover hip joint anomalies that could be address at a future dislocation. Never less the so-called Dislocation of the Hip was a quite common pathology around Europe. The close reduction of a dislocated hip has been the treatment of choice in order to attempt to reduce a dislocated hip without surgical operation. Close reduction was preferred to be obtained after a period of skin traction on bed, at which a special frame were added, to perform a progressive gentle reduction gaining, in an average of three weeks time, complete abduction before applying a spica cast. Two main methods were used: reduction with the hips extended, abducted and internal rotated according to Sommerville- Petit and reduction in over head position with the hips flexed, abducted and external rotated. These two systems were designed to decrease the Avascular Necrosis of the femoral head that often occurs if the reduction was obtained during a sudden manoeuvre under general anaesthesia. Generally the correct position of the femoral head into the acetabular socket, at the moment to apply the plaster, was assessed by an arthrogram, to avoid the bad surprise of further dislocation due to false reduction after the traction period. The child so treated had to be followed during her/his growth to assess the development of acetabular roof and the position of the femoral head linked at the antiversion of the femoral neck. Any hip joint, in which acetabular index do not improve during growth, needs acetabular and femoral osteotomies to overcome these anatomical defects as cause of a persisting genetic defect. At the end of ’80, a deep change of the natural history of D.D.H. in Italy is related to the introduction of screening programme based on accurate clinical examination of the hip of the babies at the nursery, selection of babies with risk signs of D:D.H. such as clinical anomalies, instability of the hip at Ortolani-Barlow’s, familiarity for D.D.H. and breech delivery. The hips of those babies are immediately assessed by ultrasonographic examination according to Graf’s method. The general population, on the contrary, is examined by US between the second and the third months of age. The National Health Service encourages the US screening paying its cost. In this way the incidence of late-D.D.H. and late-dislocation is enormously decreased and the outcome of the pathology has been improved. The conservative treatment of the hip affected by different grade of anomalies early discovered trough US examination, in fact, are treated by simple harness in abduction for mild dyspalsia to plaster spica cast in human position if the hip is severely unstable and Ortolani positive. There are same rare cases of true Congenital Dislocation at birth that can not be conservatively reduced and it will be necessary to perform a open reduction generally when the ossified nucleus of femoral head appeares. Our experience:. From 1975, when our Children Orthopaedic Department was created in the Medical School of “Federico II” University of Naples and the first authors become the Chief, we admitted 374 patients affected by dislocation of the hip (F=308 – M= 66 F:M= 5:1) with a mean age of 7 and half months (min.4 mths.– max 20 mths). All these patients were put in traction on the Morel’s bed in order to attempt a close reduction in extended, abducted and internal rotated position according to Sommerville- Petit method. Average time of traction was 25 days (min. 7 max 38). 120 patients were undergone at an arthrographic examination in general anaesthesia. 46 patients did not achieve the reduction and were operated on. A spica cast were applied for 60 days followed by an harness in abduction. Total amount of time of treatment was a mean of 7 months (min 110 days max. 12 months). Residual dysplasia was observed in 48 patients that needed a further surgical procedure. The number of inpatient affected by D.D.H. were an average of 21 per year until 1990 to drop dramatically at 3 per year in the last decade. On the other hand the D.D.H. outpatient clinic increased. The selected babies examined were 6930 at an average age of 4 months old. All the babies were undergone to clinical and Us examination and classified according to Graf. Hip anomalies were seen in 630 babies. The treatment was related to clinical and Us observation. Simple abduction pillow or simple harness in abduction were used in hip clinically negative at Ortolani-Barlow’s manoeuvre and 2c or 2b type according to
