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Sonographic hip screening and early management of developmental dysplasia of the hip
A Falliner1, H J Hahne, J Hassenpflug
1Department of Orthopaedics, Kiel University Hospital, Germany.
Insights
Graf's ultrasound technique accurately diagnoses developmental dysplasia of the hip (DDH) in newborns. Early detection and treatment, including abduction therapy, lead to successful hip maturation, though regular orthopedic follow-ups are crucial.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Neonatal Health
Background:
- Developmental dysplasia of the hip (DDH) is a common neonatal condition.
- Early diagnosis and intervention are critical for optimal outcomes.
- Graf's ultrasound technique is a widely used method for hip assessment.
Purpose of the Study:
- To evaluate the reliability of Graf's sonographic technique for diagnosing infantile DDH.
- To assess the natural history and treatment outcomes of DDH diagnosed sonographically.
- To identify factors influencing neonatal hip status.
Main Methods:
- Prospective study of 6,548 neonates undergoing clinical and sonographic examination.
- Follow-up of sonographic alpha angles and radiographic acetabular index (AI) angles.
- Analysis of factors such as family history, delivery mode, birth weight, and gestational age.
Main Results:
- 84.6% of hips were mature, 14.3% physiologically immature, and 1.1% dysplastic.
- 63% of sonographically dysplastic hips were clinically normal.
- 89% of type IIa hips matured spontaneously; 11% required abduction therapy, with full maturation achieved within 80 days.
Conclusions:
- Graf's sonographic technique is a reliable method for diagnosing infantile DDH.
- Spontaneous maturation occurs frequently in immature hips, but abduction therapy is effective for dysplastic hips.
- Regular orthopedic follow-up is necessary to monitor for secondary deterioration after treatment.
Abstract:
The reliability of Graf's technique in diagnosing developmental dysplasia of the hip (DDH) is investigated in this report. In a prospective study, 6,548 neonates were examined clinically and sonographically; 470 children were reexamined at least once. Sonographic alpha angles and radiographic acetabular index (AI) angles were followed up and compared. Results were as follows: 84.6% of the hips were mature; 14.3% were physiologically immature; 1.1% were dysplastic. Of the sonographically dysplastic hips, 63% were clinically normal. Neonatal sonographic hip status was affected by family history, breech delivery, birth weight, and gestational age. At follow-up, none of the primarily mature hips had worsened. Of the type IIa hips, 89% matured spontaneously, and 11% needed abduction. The 68 dysplastic hips had matured after a maximum of 80 days' abduction, with normal alpha and AI angles by the end of treatment. At 1 year, the pitch had deteriorated again in six children. Graf's sonographic technique reliably diagnoses infantile DDH. Regular orthopedic checkups are needed to detect secondary deterioration of dysplastic hips.
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