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Value of limited hip abduction in developmental dysplasia of the hip
Hakan Senaran1, H Mustafa Ozdemir, Tunç Cevat Ogün
1Selçuk University Meram School of Medicine, Department of Orthopaedics and Traumatology, Konya, Turkey.
Insights
Unilateral limited hip abduction in infants is a sensitive indicator for developmental hip dysplasia (DDH). However, ultrasound (US) remains the gold standard for diagnosis before treatment.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
Background:
- Developmental dysplasia of the hip (DDH) is often missed by physical exams.
- Limited hip abduction (LHA) in infants raises clinical suspicion for DDH.
- Ultrasound (US) is an effective screening tool for DDH, but resource-intensive.
Purpose of the Study:
- To evaluate the diagnostic value of unilateral limited hip abduction (LHA) in infants.
- To assess the correlation between LHA and ultrasound (US) findings in DDH diagnosis.
- To inform clinical decision-making regarding DDH management.
Main Methods:
- Study included 464 infants aged 30-120 days referred for LHA.
- Infants were evaluated for unilateral and bilateral LHA.
- Ultrasound (US) examinations were performed to assess hip joint status.
Main Results:
- 41% of infants presented with LHA (186/464).
- Of those with LHA, 13.9% (26/186) had unilateral LHA and 86.1% (160/186) had bilateral LHA.
- DDH was diagnosed in 7% of all infants (31/464), with a significantly higher prevalence in the unilateral LHA group (69.2%) compared to the bilateral LHA group (8.1%).
Conclusions:
- Unilateral limited hip abduction is a sensitive clinical sign for developmental hip dysplasia.
- Ultrasound remains the definitive diagnostic standard for DDH before initiating treatment.
- Clinical assessment of LHA should be complemented by US for accurate DDH diagnosis and management.
Background:
Developmental dysplasia of the hip (DDH) continues to be missed by routine physical examination in up to 50% of cases. Ultrasound (US) supplementation is the best method of screening for DDH, but the resources required should not be underestimated. Limited abduction of the hip (LHA) in an infant triggers suspicion, and often an urge to treat, in most orthopaedic surgeons and pediatricians alike. This study aimed to document the value of unilateral LHA in the diagnosis and decision making of DDH, and the correlation between LHA and US.
Methods:
In total, 464 infants referred from the pediatrics clinic with LHA, aged between 30 and 120 days, were included in the study.
Results:
Physical examination revealed LHA in 186 (41%) infants, 26 of which were unilateral and 160 were bilateral. US examination showed that 13 (8.1%) patients in the bilateral LHA group and 18 (69.2) patients in the unilateral LHA group, had DDH (total number 31, 7%).
Conclusion:
Unilateral limitation of hip abduction was found to be a sensitive sign for developmental hip dysplasia, but US could be defined once again as the best golden standard before initiating treatment.
