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Ultrasonography and radiography of the hip in infants
T Terjesen1, T O Rundén, A Tangerud
1Department of Orthopedics, Trondheim University Hospital, Norway.
Insights
Ultrasonography (ultrasound) is recommended as the primary imaging technique for suspected congenital hip dislocation in infants. Ultrasound and radiography showed high agreement, with ultrasound identifying cases that normalized spontaneously.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Developmental Dysplasia of the Hip
Background:
- Congenital dislocation of the hip (CDH) requires accurate and early diagnosis.
- Both ultrasonography and radiography are used for hip joint evaluation in infants.
- Standard diagnostic criteria include acetabular index, bony defects, and proximal femur displacement.
Purpose of the Study:
- To compare the diagnostic accuracy of ultrasonography and radiography for congenital hip dislocation.
- To evaluate the correlation between ultrasound and radiographic measurements.
- To determine the optimal primary imaging modality for suspected CDH.
Main Methods:
- Prospective study involving 156 children (2 months to 2 years) with 312 hip joints examined.
- Comparative analysis of ultrasonography and radiography findings.
- Measurement of the distance from the femoral head's ossification center to Perkins' line for correlation analysis.
Main Results:
- High agreement (303/312 hips) between ultrasound and radiography for diagnosing normal, subluxated, and dislocated hips.
- Ultrasound showed normal findings in 7 hips with radiographic dysplasia, which subsequently normalized without treatment.
- High correlation (r = 0.73) was found for the distance measurement between the two imaging modalities.
Conclusions:
- Ultrasonography is a reliable primary imaging technique for clinically suspected congenital hip dislocation.
- Ultrasound may identify cases of mild hip dysplasia that do not require intervention.
- The study supports the use of ultrasound as the initial diagnostic tool for CDH.
Abstract:
Both hip joints in 156 children, aged 2 months to 2 years, were examined by ultrasonography (ultrasound) and radiography. Pathologic findings were based on an increased acetabular index, bony defects of the lateral acetabular rim, and lateral and/or proximal displacement of the proximal femur. Each hip was classified as normal, dysplasia, subluxation, or dislocation. The same diagnosis was reached by ultrasound and radiography in 303 of the 312 hips. The accordance was good in normal joints, in subluxation, and in dislocation. However in 7 of the 15 hips with radiographic dysplasia, ultrasound was normal. These patients were not treated, and spontaneous normalization or improvement occurred in all of them. One parameter only, the distance from the lateral margin of the ossification center of the femoral head to Perkins' line, was measured by both ultrasound and radiography; the correlation was high (r = 0.73). We recommend ultrasound as the primary imaging technique when congenital dislocation is suspected clinically.