Pubo-femoral distance: an easy sonographic screening test to avoid late diagnosis of developmental dysplasia of the hip

Tréguier, C.; Chapuis, Margot; Branger, B.; Bruneau, Bertrand; Grellier, Anne; Chouklati, Kamal; Proisy, Maïa; Darnault, P.; Violas, Philippe; Pladys, Patrick; Gandon, Y.

doi:10.1007/s00330-012-2635-7

Cited by 34 publications

(50 citation statements)

References 31 publications

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“…Female gender was associated with a high percentage of DDH as compared to male infants. For many years, earlier detection of DDH in most parts of the world was based on the Ortolani [10] and Barlow [11] maneuvers. However, in recent years, numerous publications have highlighted the shortcomings of this approach, which is merely subjective findings rather than depending on the detailed morphological evaluation of the anatomopathological substrate underlying the disorder [12] [13].…”

Section: Discussionmentioning

confidence: 99%

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Role of Ultrasound in Evaluation of Developmental Dysplasia of the Hip in Infants

Ali¹,

Al-Zahrani²,

Elsayed³

et al. 2017

OJPed

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Background/Aim: The present study was directed to investigate the accuracy of ultrasound (USG) in early detection of developmental dysplasia of the hip (DDH) to prevent permanent complications. Material & Methods: A total of 276 infants was investigated; their ages range from 1 -6 months. Patients referred from the clinic based on clinical assessment (mainly Barlo & Ortolani maneuvers). Then the patient's hips were examined by expert radiologists in USG scan. After that, dynamic (coronal and transverse) & static ultrasound views evaluated by the same radiologist using Graf's criteria. Infants with abnormal ultrasound findings suggestive of DDH were followed up after 4 -6 weeks by the same investigator to monitor the progress. At the same time, the patient referred to a specialist for conservative management from the first positive findings. Results: Among the 276 referred patients, infants with normal stable hips (Graf Type I and Type II a+) were 221 (80%), 155 of them were female and 66 male infants. Infants with unstable hips based on Graf's criteria (Type II a-, II b, II c and Type III a) were 55 (20%). Out of 55 with abnormal findings, the affected hips on both sides, right and left were: 5 cases (1.8%), 7 (2.5%) and 43 hips (15.5%) consecutively. Out of 55 infants affected; 3 referred to tertiary centers for further surgical management while 52 managed conservatively. Conclusion: Delayed treatment rates of DDH and complications could be reduced by the usage of the USG after the first month of life. In addition to physical assessment, USG for high-risk infants will provide more accurate diagnosis and minimize complications.

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Section: Discussionmentioning

confidence: 99%

“…They found PFD measurement with a threshold for abnormality of 6 mm at the age of 1 month, without asymmetry above 1.5 mm, could eradicate DDH late diagnosis [11].…”

Section: Introductionmentioning

confidence: 99%

Role of Ultrasound in Evaluation of Developmental Dysplasia of the Hip in Infants

Ali¹,

Al-Zahrani²,

Elsayed³

et al. 2017

OJPed

View full text Add to dashboard Cite

show abstract

“…These findings may be explained by population characteristics (numbers included, hip morphology, age), different thresholds for treatment, or the fact that we used lateral position as opposed to supine as previously reported (Tréguier et al. 2013). Our findings support the findings of Teixeira et al.…”

Section: Discussionmentioning

confidence: 93%

“…The infant was positioned lying on its side in a specific cradle with the hip flexed in adduction, for determination of pubo-femoral distance (Tréguier et al. 2013).…”

Section: Methodsmentioning

confidence: 99%

Suggestion for new 4.4 mm pubo-femoral distance cut-off value for hip instability in lateral position during DDH screening

et al. 2018

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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.

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“…Some studies propose alternative US methods to the Graf technique and some countries and centers are adherent to these alternative methods [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

A new sign in the standard hip ultrasound image of the Graf method.

et al. 2015

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Aim: The aim of the study was to assess the usefulness of obtaining a 90 0 angle between the plane of the osteochondral plate and the surface of the transducer during standard hip ultrasonography according to Graf method. Material and methods: In this retrospective study 1078 patients (2156 hips) were included examined between 2008 and 2014 for developmental dysplasia of the hip (DDH) ultrasound screening. The patients were divided in two groups. Group I consisted of 402 patients examined between January 2008 and December 2011 using the standard Graf method. Group II consisted of 676 patients examined from January 2012 to December 2014 using the Graf method with an additional criterion: 90 0 angle between the plane of the osteochondral plate and the surface of the transducer. Results: We found more dysplastic patients in group I comparing to group II: 55 (13.7%) and 38 (5.6%) respectively. The difference in the incidence of patients diagnosed with DDH was highly significant (p<0.001). The mean alpha angle value in group I was 65.31 0 , respectively 67.52 0 for group II (p<0.001). Conclusion: The new osteochondral plate sign has the potential to reduce the overdiagnosis of DDH and provide a better tailored approach to borderline hips.

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Pubo-femoral distance: an easy sonographic screening test to avoid late diagnosis of developmental dysplasia of the hip

Abstract: PFD measurement with a threshold for abnormality of 6 mm at the age of 1 month, without asymmetry above 1.5 mm, could eradicate DDH late diagnosis.

Cited by 34 publications

References 31 publications

Role of Ultrasound in Evaluation of Developmental Dysplasia of the Hip in Infants

Role of Ultrasound in Evaluation of Developmental Dysplasia of the Hip in Infants

Suggestion for new 4.4 mm pubo-femoral distance cut-off value for hip instability in lateral position during DDH screening

A new sign in the standard hip ultrasound image of the Graf method.

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