Value of the First Examination for Developmental Dysplasia of the Hip - Our Experiences

Abstract

Developmental dysplasia of the hip (DDH) means a distinct dislocation (lateralisation and cranialisation) of the femoral head from the poorly developed (hypoplastic and steeper) acetabulum.The aim of the paper was to establish, in a retrospective and prospective study conducted in the period between January 1, 2006 and December 31, 2010, the total number and characteristics of instances of DDH in the first clinical and ultrasound examinations in newborns examined at the Traumatology Clinic of the Clinical Centre in Banja Luka.Six thousand one hundred thirty-two children were examined and 99 were treated. The percentage of girls among the treated children was considerably higher (96%). The ultrasound examination was performed first and was followed by the clinical examination. The ultrasound examination of all babies was performed with an electronic 5-12-MHz probe, using the standard Graf's method.7.8% of the cases, mostly primiparae, had a positive family history of DDH. The incidence diagnosed clinically amounted to 8.87%, and the incidence diagnosed by ultrasound to 1.61%. The first clinical examination diagnosed a limited abduction of the right hip in 12.1% of the newborns, while limited abduction of the left hip was present in 96.0%. Ortolani's sign in the right hip was positive in 3.0% and in 33.3% patients it was positive in the left hip. 3.0% of the newborns had a positive Palmen sign in the right hip in the first examination, and 42.4% in the left. 3% of the patients had asymmetric skin creases on the right upper leg, while 87.9% of the patients had them on the left upper leg. 46.5% of the patients had crepitations in their right hip, while 83.8% had crepitations in the left hip. 2% of the patients had a lax right hip, while 3% had a lax left hip. The results obtained from the ossified acetabulum of the right hip in the examined sample were as follows: good in 91.9%, satisfactory in 5.1%, insufficient (deficient) in 2.0%, and bad in 1.0% of the cases. The results from the left ossified acetabulum were as follows: good in 3.0%, satisfactory in 44.4%, insufficient (deficient) in 45.5 %, bad in 7.1% of the cases. The bony protrusion -acetabular labrum on the right hip was angular in 90.9%, obtuse (fused) in 1.0%, round in 7.1%, round to flat and flat in 1.0% of the cases. The bony protrusion -acetabular labrum on the left hip was angular in 2.0 %, obtuse (fused) in 2.0%, round in 81.8%, round to flat and flat in 14.1% of the cases.It is important to commence with diagnosing and treating DDH as early as possible by applying atraumatic aids and procedures while all structures are elastic, reducible and adaptable.The clinical examination is unreliable in terms of diagnosis of DDH, but it is mandatory as a part of the full physical examination of a newborn baby.