Background and purpose — Current selective screening algorithms for developmental dysplasia of the hip (DDH) are insufficient. Universal screening programs have been proposed but so far have been deemed too expensive and time consuming. The pubo-femoral distance may solve this problem as a quick, low-cost, highly sensitive, and specific sonographic measurement for DDH, but this has only been validated in the supine position. Therefore we validated pubo-femoral distance (PFD) in the lateral position as an indicator for instability of the hip.Methods — All participants had undergone ultrasonographic diagnostics using the modified Graf technique. In addition, PFD measurements in lateral position were performed. Results were compared between 25 infants who had been treated for DDH because of dysplastic appearance on ultrasound combined with clinical instability and a control group consisting of 100 untreated infants screened for DDH. Sensitivity, specificity, and cut-off points were determined using Receiver operating characteristics (ROC) analysis.Results — We found a mean PFD of 6.8 mm (6.2–7.4) in the treated group with a control group PFD of 3.4 mm (3.3–3.6) (p < 0.005). A PFD value above a threshold of 4.4 mm yielded a sensitivity of 100% and a specificity of 93% for detecting unstable DDH.Interpretation — PFD measured in lateral position was statistically significantly increased in hips of children treated for DDH with Denis Browne hip brace compared with healthy children with unaffected stable hips. Furthermore, the PFD measurement had a high level of sensitivity and specificity at a cut-off value of 4.4 mm. A cut-off value of 6.00 mm has previously been reported as the gold standard in supine position. We suggest that 4.4 mm is used in lateral position.

Developmental dysplasia of the hip (DDH) is a term that incorporates a spectrum of disorders of the hip, ranging from mild dysplasia to complete irreducible hip dislocation. 1 In Denmark, a combination of universal clinical screening and selective ultrasound screening for DDH is implemented. Official national guidelines recommend a clinical hip examination by a midwife after birth which is repeated at a 5-week follow up by a general practitioner. 2 In supplement to the nationally recommended clinical examinations, screening for recognised risk factors for DDH has been implemented regionally.

BackgroundThe positive predictive value of clinical hip examinations performed by generalist health professionals in screening for developmental dysplasia of the hip (DDH) is low.AimTo assess the self-reported recognition of nationally recommended clinical hip examinations in the screening programme for DDH in Denmark among midwives, general practitioners (GPs), and GPs in training.Design & settingA web based open survey study among Danish midwives, GPs and GPs in trainingMethodRespondents were asked to identify which of six written statements of clinical hip examinations were featured in the national Danish guidelines on DDH screening. Three statements were the official statements of the Ortolani, Galeazzi, and hip abduction examinations from the national guidelines and three statements were false and constructed by the author group. Participants were asked to select up to six statements.ResultsA total of 178 (58 GPs, 97 midwives and 23 GPs in training) responses were included.Eighty-nine per cent of responders correctly identified the Ortolani manoeuvre and 92% correctly identified one of the constructed descriptions as being false. The remaining four descriptions had significantly lower correct answer percentages ranging from 41% to 58% with significantly lower correct answer percentages of midwives for three out of all six descriptions when compared to GPs.ConclusionWe conclude that the recognition of two out of three recommended clinical hip examinations in the Danish screening program for DDH is overall low among current screeners. Efforts should be made to heighten the knowledge level by further education of screeners.

The pubo-femoral distance (PFD) has been suggested as an ultrasound screening tool for developmental dysplasia of the hip (DDH). The aim of this study was to examine if midwives undergoing minimal training could reliably perform pediatric hip ultrasound and PFD measurements. Eight recruited midwives performed two rounds of independent blinded PFD measurements on 15 static ultrasound images and participated in four supervised live-scanning sessions. The midwives were compared to a group of three experienced musculoskeletal radiologists. Reliability was evaluated using inter-rater correlation coefficients (ICC). Linear regression was used to quantify the learning curve of the midwives as a group. There was near complete intra- and inter-rater agreement (ICC > 0.89) on static ultrasound images across both rounds of rating for midwives and radiologists. The midwives performed a mean of 29 live hip scans (range 24–35). The mean difference between midwives and supervising radiologists was 0.36 mm, 95% CI (0.12–0.61) for the first session, which decreased to 0.20 mm, 95% CI (0.04–0.37) in the fourth session. ICC for PFD measurements increased from 0.59 mm, 95% CI (0.37–0.75) to 0.78 mm, 95% CI (0.66–0.86) with progression in sessions. We conclude that midwives reliably perform PFD measurements of pediatric hips with minimal training.