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Screening for developmental dysplasia of the hip: results of a 7-year follow-up study
Figen Sahin1, Aysima Aktürk, Ufuk Beyazova
1Department of Pediatrics, Gazi University, Faculty of Medicine, Turkey. figens2001@yahoo.com
Insights
Early screening for developmental dysplasia of the hip (DDH) in infants is crucial. A careful history and physical examination are effective tools for identifying DDH cases during routine check-ups.
Area of Science:
- Pediatrics
- Orthopedics
- Public Health
Background:
- Developmental dysplasia of the hip (DDH) screening is recommended for all infants to prevent long-term disability.
- Late diagnosis of hip dislocation can lead to significant complications.
- This study evaluates the efficacy of DDH screening in a Turkish clinic over seven years.
Purpose of the Study:
- To assess the results of developmental dysplasia of the hip screening in infants.
- To determine the diagnostic value of risk factors and physical examination findings in DDH detection.
Main Methods:
- A retrospective review of hospital records for 5798 infants from January 1995 to December 2001.
- Infants with risk factors or suggestive physical findings were referred for orthopedic evaluation.
- Sensitivity, specificity, and predictive values were calculated for risk factors and examination findings.
Main Results:
- Ten out of 5798 infants were diagnosed with DDH.
- Risk factors were present in 111 infants; abnormal physical findings in 606.
- Physical examination demonstrated 100% sensitivity and 88.9% specificity for DDH.
Conclusions:
- A thorough patient history and physical examination are fundamental for DDH screening.
- Regular hip examinations during well-child visits facilitate early DDH identification.
- Combined history and physical exam findings offer a sensitive screening approach for DDH.
Background:
Screening for developmental dysplasia of the hip (DDH) is widely recommended for all infants to prevent disability from late diagnosis of dislocation of the hip. The present study evaluates the results of screening for developmental dislocation of hip in a clinic in Turkey over the course of 7 years.
Methods:
Hospital records of 5798 infants who were examined regularly until walking age at Gazi University well child clinics between January 1995 and December 2001 were reviewed. Infants with known risk factors for DDH such as breech presentation, family history of DDH or swaddling, and of infants with physical examination findings suggestive of DDH, were referred to orthopedic surgeons for diagnosis. Based on this final diagnosis, sensitivity, specificity, positive and negative predictive values of risk factors and physical examination findings were calculated.
Results:
Of the 5798 infants, risk factors were detected in the medical history of 111 infants, and in 14 infants a musculoskeletal deformity was detected. In 606 infants the physical examination findings were suggestive of DDH. Ten patients were subsequently diagnosed with DDH. The sensitivity, specificity, positive predictive value and negative predictive values of having a risk factor for DDH in history were 10.0%, 98.1%, 0.9%, 99.8%, and having abnormal hip examination findings were 100.0%, 88.9%, 1.6% and 100.0%, respectively.
Conclusions:
A careful history and physical examination is the cornerstone of DDH screening. Serial hip examinations performed during health examination visits provide an opportunity to identify DDH cases. The sensitivity of risk factors in history and physical examination findings together is high enough to be accepted as a screening tool.