The predictive value of the clinical sign of limited hip abduction for developmental dysplasia of the hip (DDH)

Abstract

<p><strong>Aim<br /></strong> To assess the relationship between the clinical sign of limited hip abduction and developmental dysplasia of the hip (DDH). <strong>Methods<br /></strong> A research was conducted on 450 newborns at the Neonatal Unit at the Clinic of Gynaecology and Obstetrics and the Orthopaedics and Traumatology Clinic of the University Clinical Centre, Tuzla, between 30 th August 2011 and 30 th April 2012. Clinical (degree of hip abduction) and ultrasound examination of all newborns' hips were performed using the Graf method on their first day of life. <br /><strong>Results</strong> <br />Clinical sign of limited hip abduction showed significant predictive value for DDH. There were 67 (14.7%) newborns with the clinical sign of limited hip abduction, of which 26 (5.7%) were on the left hip, 11 (2.4%) on the right hip and 30 (6.6%) on both hips. Limited hip abduction had a positive predictive value (PPV) of 40.3% and a negative predictive value (NPV) of 80.4% for DDH.<br /><strong> Conclusion<br /></strong> Limited hip abduction, especially unilateral, is a useful and important clinical sign of DDH. Doctors, who perform the first examination of the child after birth, would have to pay attention to this clinical sign. Newborns with this clinical sign would have to go to an ultrasound examination of the hips for further diagnosis.</p>

Screening of Developmental Dysplasia of the Hip in Europe: A Systematic Review

“…In this review, we compiled many studies, allowing us to determine which countries screen universally (Austria [1,[23][24][25], Bosnia and Herzegovina [26], Poland [47], Slovenia [14,48], the Czech Republic [27,28,64], and Germany [34][35][36][37]) and selectively (the United Kingdom [21,[52][53][54][55][56][57], Italy [29,43,44], Denmark [30][31][32], Spain [49,50], the Netherlands [11,45], Hungary [40], Norway [19,46], France [18,33], Ireland [17,41,42], Greece [38], Sweden [20], and Ukraine [51]). Summarised information on DDH screening approaches can be found in Table 1.…”

“…Screening approach in the Czech Republic is presented in Figure 3. Bosnia and Herzegovina does not currently have an established screening pro gramme [26]; however, the authors of the study conducted a universal physical and ultra sound examination of the hip on the day of birth. All were performed by an orthopaedi surgeon using Graf's ultrasound method.…”

Epidemiology and Screening of Developmental Dysplasia of the Hip in Europe: A Scoping Review

“…Laborie et al conducted a randomized trial regarding the use of universal ultrasound; ultrasound use increased the early diagnosis of DDH to a nonstatistically significant level; however, in the long-term this was not clinically significant as it did not influence the frequency of chronic complications of the disease [17]. A study by Čustović et al also appears to be in favor of a simple clinical examination; it was shown that unilateral limited hip abduction could a valuable clinical sign of DDH (positive predictive value = 40.3% and negative predictive value = 80.4%), which could be used for diagnostic purposes [18] There has been, however, contradictory evidence regarding the effectiveness of DDH screening with a simple clinical examination, as many cases of DDH still remain undiagnosed when using this approach [7]. Reidy et al investigated the screening effectiveness of the hip examination at 6-8 weeks, performed by a general practitioner, and found that the sensitivity of examination was only 19.4%, as well as that four of five children with DDH remained undiagnosed [19].…”