Real-time ultrasound in the diagnosis of congenital dislocation and dysplasia of the hip

Abstract

A technique of examining the infant hip joint with real-time ulfrasound is described. Since the cartilaginous femoral head is clearly imaged by ultrasound, anatomical structures and their relationships can be accurately determined. Dislocated hips are easily detected and subluxations also can be visualised. We report our experience with 131 examinations in 104 patients, comprising 259 single hip studies. Of 83 patients who were previously untreated, there were 178 hip studies with three false-negative and four falsepositive ulfrasound results. No dislocations were missed. Twenty-seven patients who were already being treated were examined to assess hip location, comprising a total of 81 hip studies. In some cases the patients were examined while in an abduction device, cast, or Pavlik harness. In one case a disloction was not detected. The method of examination using real-time ultrasound is considered to be reliable, accurate, and a useful adjunct to radiography. The advantages are that it is non-invasive, portable, and involves no exposure to radiation. The diagnosis of instability and dysplasia in the hip of the newborn infant remains difficult. Although clinical

Neonatal foot deformities and their relationship to developmental dysplasia of the hip

“…Paediatricians diagnosed deformities of the foot in 614 of these infants and referred them to the paediatric orthopaedic clinic as part of a screening programme for DDH. The senior author (RWP) examined all the hips clinically using the Barlow and Ortolani tests 11 and ultrasonographically using Harcke's dynamic [12][13][14] and modified Graf's static morphological methods. [15][16][17] A simplified Graf classification was used in which a Graf angle of over 60° was classified as normal (type I), of 43° to 60° as type II, and below 43°a nd stable as type III.…”

Developmental dysplasia of the hip: What has changed in the last 20 years?

“…At this stage radiographs become more reliable [5] . Real-time ultrasonography has been established as an accurate method for imaging of the hip during the first few months of life [44][45][46][47][48][49][50] . In patients treated for DDH, a delay in appearance of the femoral head ossification center is commonly seen, even up to 1 year after hip reduction.…”

Neonatal Detection of Developmental Dysplasia of the Hip (Ddh)

“…[20][21][22][23][24][25] It offers specificity and sensitivity in excess of 90%, 19 but it is not infallible. The images can be difficult to interpret, it overdiagnoses the condition, it does not tell us whom to treat and it poses logistical problems in organisation.…”