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[Screening and diagnosis of hip instability in newborn infants]
1Service d'orthopédie pédiatrique, hôpital Saint-Vincent-de-Paul, Paris.
Insights
Congenital hip dislocation is identified by instability. Clinical examination is reliable for detection, with ultrasonography as a useful diagnostic aid when needed.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Developmental Dysplasia of the Hip
Context:
- Congenital dislocation of the hip (CDH) presents with instability as the primary clinical sign.
- Diagnostic methods for hip instability vary in reliability, with snapping being an inconsistent indicator.
- The unpredictable natural course of CDH necessitates treatment for all dislocated hips.
Purpose:
- To evaluate the diagnostic value of clinical examination versus other methods for detecting hip instability.
- To determine the reliability and risks associated with clinical examination in diagnosing CDH.
- To establish criteria for identifying hips at risk of dislocation and justify clinical detection.
Summary:
- Clinical examination is a primary method for detecting hip instability in congenital dislocation of the hip.
- Ultrasonography with dynamic testing can supplement clinical examination when uncertainty exists.
- The unpredictable nature of CDH supports the rationale for treating all identified dislocated hips.
Impact:
- Highlights the importance of clinical assessment in the early diagnosis of CDH.
- Provides guidance on the judicious use of diagnostic imaging in conjunction with clinical findings.
- Emphasizes a proactive treatment approach for congenital hip dislocation based on clinical detection.
Abstract:
Instability is the clinical sign that characterizes congenital dislocation of the hip. The methods used to detect hip instability do not all have the same value, and snapping is only an accessory and inconstant sign. In case of doubt, ultrasonography with dynamic test may be a useful complement to clinical examination. The natural course of the disease being unpredictable, treating all dislocated hips seems to be justified. The author discusses the risks and reliability of clinical examination and the criteria of hips at risk of dislocation to conclude in favour of clinical detection.