Ultrasound in the management of the position of the femoral head during treatment in a spica cast after reduction of hip dislocation in developmental dysplasia of the hip

Douveren, Florens Q. M. P. van; Pruijs, Hans; Sakkers, R. J. B.; Nievelstein, Rutger A.J.; Beek, F. J. A.

doi:10.1302/0301-620x.85b1.12665

Cited by 50 publications

(47 citation statements)

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“…With that probe both hips were imaged simultaneously. In 2003 van Douveren et al [8] described sonography after closed or open reduction in the operating room. Those authors compared sonographic findings to CT, which was performed a few minutes later.…”

Section: Discussionmentioning

confidence: 99%

“…When we implemented transinguinal sonography in our practice we compared the sonographic results with CT scans [8]. The results showed that sonography was sufficient to demonstrate a normal position of the femoral head.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, after reduction an echogenic rim of tissue is almost invariably seen between the acetabulum and the repositioned femoral head. On CT this is shown to consist of interposed fatty tissue, also named pulvinar [8]. The normal hip does not show this interposed echogenic tissue.…”

Section: Discussionmentioning

confidence: 99%

“…Lastly, although sonography is observer-dependent, it is fairly easy to evaluate the position of the femoral head. Several reports regarding sonographic evaluation were published, mostly in the orthopaedic literature [6–8]. This application of sonography was termed “transinguinal sonography” [2].…”

Section: Introductionmentioning

confidence: 99%

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Transinguinal sonographic determination of the position of the femoral head after reposition and follow-up in a spica cast

et al. 2010

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BackgroundTransinguinal sonography can be used to demonstrate the position of the femoral head after reduction of a dislocated hip.ObjectiveTo determine whether transinguinal sonography can replace radiography and CT in the follow-up after reduction of a hip dislocation?Materials and methodsThirty-three children with 39 dislocated hips were followed up with sonography after reduction and immobilization in a spica cast. In cases of an abnormal position a CT scan was advised. A pelvic radiograph at the end of treatment served as an indicator that no dislocations were missed during the previous sonographic examinations.ResultsThe repositioned hips were examined on 138 occasions. Twenty-four examinations were abnormal and CT scanning was performed on 11 occasions. In four children additional CT was done because a recurrent dislocation was suspected or because sonography was difficult to perform. No dislocations were demonstrated. In five children a recurrent dislocation was suspected, on one or more occasions. In all but one child a CT scan was performed that confirmed the dislocation.ConclusionTransinguinal sonography is well-suited to demonstrate a normal position of the femoral head in a spica cast. Transinguinal sonography decreases the number of radiographs and CT scans and reduces the exposure to ionizing radiation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transinguinal sonographic determination of the position of the femoral head after reposition and follow-up in a spica cast

et al. 2010

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“…A close collaboration between surgeons and radiologists is necessary in order to optimize the perineal opening to place a US-transducer through a cast [15].…”

Section: In 1997 Mcnally Et Al [4]mentioning

confidence: 99%

MRI in Hip Dysplasia: How to Shorten your MR-Protocol?

Stranzinger¹,

Adrian²,

Tomas³

et al. 2015

Orthop Muscular Syst

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ObjectiveCongenital hip dysplasia is a common orthopedic disorder in childhood. MRI is widely used to image high grade dysplastic hips after reduction and fixation within a cast. The purpose of this study was to optimize and shorten the MR study to the requests of the pediatric orthopedic surgeons. Material and Methods13 consecutive MR studies of the hip were included in the study (1-5 months of age) between 2003 and 2011. Two pediatric orthopedic surgeons, who were blind for the diagnosis and therapy of the study patients, evaluated all magnetic resonance images (MRI) to determine the type of hip dysplasia. The usefulness of the MR-images was assessed using a 5-point scale. The type of hip dysplasia was assessed using the Tönnis criteria. In addition two radiologists in consensus evaluated the status of sedation and motion artifacts. Original MRI-reports were reviewed. ResultsThe most valuable sequences for the position of the femoral head and the evaluation of the anatomic details of the 13 MR-studies were: (a) In coronal planes: TIRM 3 mm (Score 4.6), T2 TSE 3mm (Score 4.1). (b) In axial planes: PD axial 3mm (Score 4.75), DESS reformats 1.5 mm (Score 4.5). (c) All sagittal sequences and non-fat saturated T1w images were not supportive for the orthopedic surgeons. Mild and major motion artifacts are observed in 33% of the patients with sedation and in 71% without sedation. ConclusionAfter reduction of high-grade hip dysplasia and Spica-cast fixation, MRI examination offers valuable information for the orthopedic surgeon. The MRI study may fulfill the orthopedic surgeon's needs using only one coronal and axial plane (e.g. T2w, PD or DESS) to image the dysplastic hip after treatment in a Spica-cast reliably. The shortening of the protocol may reduce the requirement of general anesthesia or sedation, however optimal images without motion artifacts play an important role in image interpretation.

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Intraoperative Contrast‐Enhanced Ultrasound Imaging of Femoral Head Perfusion in Developmental Dysplasia of the Hip: A Feasibility Study

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Chauvin²,

Ntoulia

et al. 2019

J of Ultrasound Medicine

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Objectives Developmental dysplasia of the hip (DDH) is one of the most common developmental deformities of the lower extremity. Although many children are successfully treated with a brace or harness, some require intraoperative closed or open reduction and spica casting. Surgical reduction is largely successful to relocate the hip; however, iatrogenic avascular necrosis is a major source of morbidity. Recent research showed that postoperative gadolinium‐enhanced magnetic resonance imaging (MRI) can depict hip perfusion, which may predict a future incidence of avascular necrosis. As contrast‐enhanced ultrasound (CEUS) assesses blood flow in real time, it may be an effective intraoperative alternative to evaluate femoral head perfusion. Here we describe our initial experience regarding the feasibility of intraoperative CEUS of the hip for the assessment of femoral head perfusion before and after DDH reduction. Methods This single‐institution retrospective Institutional Review Board–approved study with a waiver of informed consent evaluated intraoperative hip CEUS in children with DDH compared to postoperative contrast‐enhanced MRI. Pediatric radiologists, blinded to prior imaging findings and outcomes, reviewed both CEUS and MRI examinations separately and some time from the initial examination both independently and in consensus. Results Seventeen patients had 20 intraoperative CEUS examinations. Twelve of 17 (70.6%) had prereduction hip CEUS, postreduction hip CEUS, and postreduction gadolinium‐enhanced MRI. Seven of 12 (58.3%) were evaluable retrospectively. All CEUS studies showed blood flow in the femoral epiphysis before and after reduction, and all MRI studies showed femoral head enhancement after reduction. The CEUS and MRI for all 7 patients also showed physeal blood flow. Conclusions Contrast‐enhanced ultrasound is a feasible intraoperative tool for assessing adequate blood flow after hip reduction surgery in DDH.

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Ultrasound in the management of the position of the femoral head during treatment in a spica cast after reduction of hip dislocation in developmental dysplasia of the hip

Cited by 50 publications

References 12 publications

Transinguinal sonographic determination of the position of the femoral head after reposition and follow-up in a spica cast

Transinguinal sonographic determination of the position of the femoral head after reposition and follow-up in a spica cast

MRI in Hip Dysplasia: How to Shorten your MR-Protocol?

Intraoperative Contrast‐Enhanced Ultrasound Imaging of Femoral Head Perfusion in Developmental Dysplasia of the Hip: A Feasibility Study

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