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Late presenting dislocation of sonographically stable hips
David P Gwynne Jones1, John D Dunbar, Jean-Claude Theis
1University of Otago, Dunedin, New Zealand. david.gwynne-jones@stonebow.otago.ac.nz
Insights
Ultrasound may miss developmental hip dislocations even in stable hips. Infants with initial instability require follow-up pelvic X-rays at 4-6 months for accurate diagnosis.
Area of Science:
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
- Diagnostic Imaging
Background:
- Developmental Dysplasia of the Hip (DDH) is a common condition.
- Early diagnosis and treatment are crucial for optimal outcomes.
- Ultrasound is a primary imaging modality for infants under six months.
Observation:
- Seven cases of developmental hip dislocation were observed in five infants (6-22 months).
- These dislocations occurred despite previous ultrasound findings of reduced and stable hips.
- Four hips initially diagnosed with clinical instability (Barlow positive) at birth had stabilized by ultrasound scan (16-45 days).
Findings:
- Reduced and sonographically stable hips at 2-6 weeks of age can still dislocate later.
- Femoral head coverage in affected hips ranged from 36% to 56%.
- One hip showed minimal laxity on stress sonography.
Implications:
- Ultrasound findings of stability do not exclude the possibility of subsequent dislocation.
- Infants with a history of neonatal hip instability warrant further investigation with pelvic radiography at 4-6 months.
- This highlights the limitations of early ultrasound in predicting long-term hip stability.
Abstract:
We report on seven developmental hip dislocations in five babies (age 6-22 months) in whom ultrasound had demonstrated reduced and stable hips. Four hips in three babies had been diagnosed as having clinical instability (Barlow positive) at birth, which had stabilized by the time of the scan (16-45 days). Femoral head coverage ranged from 36 to 56%. One hip had minimal sonographic laxity on stress examination. Hips that are reduced and stable sonographically at 2-6 weeks of age can subsequently dislocate. Any child with instability at birth should be reviewed with a pelvic radiograph at 4-6 months, even if an ultrasound scan appears to be normal.
