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Magnetic resonance imaging-guided closed reduction treatment for developmental dysplasia of the hip
J E Vandevenne1, T Lincoln, K Butts Pauly
1Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305, USA. vdvennej@hotmail.com
Insights
This study outlines magnetic resonance (MR) imaging-guided closed reduction for developmental dysplasia of the hip (DDH). It details the radiologist's role and specific MR sequences for successful hip reduction in infants.
Area of Science:
- Orthopaedic Surgery
- Radiology
- Medical Imaging
Background:
- Developmental dysplasia of the hip (DDH) requires effective treatment strategies.
- Closed reduction is a key intervention for DDH.
- Magnetic resonance (MR) imaging offers advanced visualization capabilities for guiding procedures.
Purpose of the Study:
- To describe the radiological aspects of MR imaging-guided closed reduction for DDH.
- To detail the procedural steps involved in this technique.
- To guide radiologists in collaborating with orthopaedic surgeons.
Main Methods:
- Utilized a custom-made hip spica table with a vertically open MR imaging unit (0.5T).
- Employed standard and rapid dynamic MR imaging sequences, including fluoroscopic echo-planar imaging.
- Described and illustrated five distinct procedural steps for the radiologist.
Main Results:
- Defined five procedural steps: positioning, static evaluation, dynamic reduction imaging, cast application with imaging, and postprocedural imaging.
- Highlighted the radiologist's focus and imaging actions at each step.
- Demonstrated the visualization of hip reduction and dislocation using dynamic MR sequences.
Conclusions:
- The radiologist's role is clearly defined throughout the MR imaging-guided closed reduction procedure.
- Specific MR sequences and image interpretation are crucial for successful outcomes.
- Understanding these steps facilitates efficient collaboration and effective DDH treatment.
Introduction:
This study aimed to describe the radiological aspects and procedural steps of magnetic resonance (MR) imaging-guided closed reduction for the treatment of developmental dysplasia of the hip (DDH).
Methods:
Infants were positioned on a custom-made hip spica table attached to a vertically open double doughnut-shaped MR imaging unit (GE Signa SP, 0.5T) affording access to one orthopaedic surgeon and one radiologist. Standard MR imaging sequences and rapid dynamic MR imaging sequences, including fast spin-echo, fast gradient-echo and a fluoroscopic echo-planar sequence, were available. Procedural steps were described and illustrated as a guide for the radiologist actively collaborating with the orthopaedic surgeon.
Results:
Five separate procedural steps were defined, describing the imaging action and the radiologist's focus related to the clinical action. These procedural steps included patient positioning, static imaging to evaluate hip congruency and factors impeding reduction, dynamic stress testing and reducing the hip while using dynamic motion MR imaging sequences to visualise reduction or dislocation, cast application with intermittent imaging confirmation of the femoral head position, and postprocedural static imaging.
Conclusion:
The role of the radiologist was well-defined during each procedural step of the MR imaging-guided closed reduction focusing on the use of specific sequences and image interpretation. Knowledge of these procedural steps may be helpful for efficient collaboration with the orthopaedic surgeon and successful MR imaging-guided treatment of DDH.
