Transgluteal ultrasonography in spica cast in postreduction assessment of developmental dysplasia of the hip

Mehdizadeh, Mehrzad; Dehnavi, Mehrshad; Tahmasebi, Aylin; Shishvan, Seyed Amir Mahlisha Kazemi; Kondori, Nasir Babakhan; Shahnazari, Razieh

doi:10.1007/s40477-019-00408-y

Cited by 9 publications

(7 citation statements)

References 27 publications

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“…Postoperative radiography alone appears to be inadequate for assessing whether the hip is reduced or dislocated, and surgeon experience and subspecialty training cannot prevent errors [22]. Although there has been some research on the use of ultrasound in this field [2,5,11,17,19], the spica cast and commonly used probes limit the applicability of ultrasound. We therefore developed hip medial ultrasound, using a microconvex probe, and set the acetabulum coronal mid sectional plane as the fixed section for the index measurement.…”

Section: Discussionmentioning

confidence: 99%

“…During cast immobilization, surgeons need to accurately assess the status of hip reduction to ensure successful treatment and avoid complications [1]. Radiography [21], CT [3,15], and MRI [4,8,11,12,14] have been used to assess reduction status. However, radiography and CT cannot show the details of cartilage very well, and those modalities are associated with radiation; MRI also has disadvantages, such as the need for sedation, high costs, and long scanning times.…”

Section: Introductionmentioning

confidence: 99%

“…However, radiography and CT cannot show the details of cartilage very well, and those modalities are associated with radiation; MRI also has disadvantages, such as the need for sedation, high costs, and long scanning times. More recently, ultrasound has been used to assess reduction in patients with DDH who are treated with cast immobilization after reduction [2,5,11,17,19].…”

Section: Introductionmentioning

confidence: 99%

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Is Hip Medial Ultrasound More Accurate Than Radiography for Determining the Status of Hip Reduction in Children Treated With a Spica Cast? A Retrospective Diagnostic Accuracy Study

Chen

Lyu³

et al. 2022

Clin Orthop Relat Res

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is Hip Medial Ultrasound More Accurate Than Radiography for Determining the Status of Hip Reduction in Children Treated With a Spica Cast? A Retrospective Diagnostic Accuracy Study

Chen

Lyu³

et al. 2022

Clin Orthop Relat Res

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“…If the plaster is removed or a window is cut on the plaster, the integrity of the plaster would be weakened, which increases the risk of femoral head dislocation [23,24]. In addition, transinguinal ultrasound and transgluteal ultrasonography were reported to determine the position of the femoral head in relation to the acetabulum in a spica cast, which were satisfactory methods [25,26]. However, adequate application of both methods and interpretation of relevant results require certain training time and much operational experience.…”

Section: Discussionmentioning

confidence: 99%

Anteroposterior pelvic radiograph is not sufficient to confirm hip reduction after conservative treatment of developmental dysplasia of the hip

Fan¹,

Wang²,

Pang³

et al. 2022

Journal of Pediatric Orthopaedics B

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The purpose of this study was to investigate whether an anteroposterior pelvic radiograph alone is sufficient to confirm hip reduction after conservative treatment or whether MRI could be alternatively performed. A total of 133 children (145 hips) were enrolled. All children were examined by anteroposterior pelvic radiographs and MRI. Three experts interpreted anteroposterior pelvic radiographs and then verified these results on MRI. For patients with inconsistent results between anteroposterior pelvic radiographs and MRI, the continuity of Shenton’s line and Calve’s line was recorded, and the medial clear space of bilateral hips was measured for unilateral cases. There was complete agreement between the three experts in the interpretation of anteroposterior pelvic radiographs of 111 (76.55%) hips; there was disagreement in the remaining 34 hips, with two experts diagnosing satisfactory reduction in 13 hips and dislocation in 21 hips. Assuming that the judgment of two or more doctors on anteroposterior pelvic radiographs was taken as the final result, 17 hips (11.72%) were misjudged. There was no statistically significant difference between the actual in-position group and the actual dislocation group in terms of the continuity of Shenton’s line (P = 0.62) and Calve’s line (P = 0.10) and the medial clear space of bilateral hips (P = 0.08). In children less than 1 year of age with developmental dysplasia of the hip treated conservatively, the use of anteroposterior pelvic radiographs alone to judge hip reduction might result in misdiagnosis and missed diagnosis. MRI could be alternatively used to detect hip reduction after conservative treatment, especially when the doctor was not familiar with ultrasound in the presence of plaster.

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“…The algorithm varies in the case of spica casting. Some prefer leaving window in the cast to perform a transinguinal ultrasound [ 14 , 15 , 16 ]. This additional window reduces the stability of the cast, which is why others prefer magnetic resonance imaging (MRI) to evaluate the position of the femoral head after closed reduction and cast application [ 17 , 18 , 19 , 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Outcome Prognostic Factors in MRI during Spica Cast Therapy Treating Developmental Hip Dysplasia with Midterm Follow-Up

et al. 2022

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Closed reduction followed by spica casting is a conservative treatment for developmental dysplasia of the hip (DDH). Magnetic resonance imaging (MRI) can verify proper closed reduction of the dysplastic hip. Our aim was to find prognostic factors in the first MRI to predict the possible outcome of the initial treatment success by means of ultrasound monitoring according to Graf and the further development of the hip dysplasia or risk of recurrence in the radiological follow-up examinations. A total of 48 patients (96 hips) with DDH on at least one side, and who were treated with closed reduction and spica cast were included in this retrospective cohort study. Treatment began at a mean age of 9.9 weeks. The children were followed for 47.4 months on average. We performed closed reduction and spica casting under general balanced anaesthesia. This was directly followed by MRI to control the position/reduction of the femoral head without anaesthesia. The following parameters were measured in the MRI: hip abduction angle, coronal, anterior and posterior bony axial acetabular angles and pelvic width. A Graf alpha angle of at least 60° was considered successful. In the radiological follow-up controls, we evaluated for residual dysplasia or recurrence. In our cohort, we only found the abduction angle to be an influencing factor for improvement of the DDH. No other prognostic factors in MRI measurements, such as gender, age at time of the first spica cast, or treatment involving overhead extension were found to be predictive of mid-term outcomes. This may, however, be due to the relatively small number of treatment failures.

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Transgluteal ultrasonography in spica cast in postreduction assessment of developmental dysplasia of the hip

Cited by 9 publications

References 27 publications

Is Hip Medial Ultrasound More Accurate Than Radiography for Determining the Status of Hip Reduction in Children Treated With a Spica Cast? A Retrospective Diagnostic Accuracy Study

Is Hip Medial Ultrasound More Accurate Than Radiography for Determining the Status of Hip Reduction in Children Treated With a Spica Cast? A Retrospective Diagnostic Accuracy Study

Anteroposterior pelvic radiograph is not sufficient to confirm hip reduction after conservative treatment of developmental dysplasia of the hip

Outcome Prognostic Factors in MRI during Spica Cast Therapy Treating Developmental Hip Dysplasia with Midterm Follow-Up

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