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Ultrasound of the infant hip: manual fixation is equivalent to Graf's technique regarding image quality-a randomized
Peter Voitl1,2,3, Christian Sebelefsky4, Sara Hosner3
1First Vienna Pediatric Medical Center, Donau-City-Straße 1, 1220, Vienna, Austria.
Insights
Manual fixation by parents is as effective as Graf's technique for infant hip ultrasound screening. This study found no difference in image quality for developmental dysplasia of the hip screening in healthy infants.
Area of Science:
- Pediatric imaging
- Orthopedics
- Medical diagnostics
Background:
- Ultrasonography is the standard for infant hip dysplasia screening in Middle Europe.
- Graf's technique is a common method for infant hip ultrasound.
Purpose of the Study:
- To compare the image quality of manual infant fixation by parents versus Graf's fixation technique.
- To determine if manual fixation is equivalent to Graf's technique for hip ultrasound screening.
Main Methods:
- A randomized trial involving healthy infants aged 1 week and 6-8 weeks.
- Infants were randomized into two groups: Graf's fixation device and manual fixation by parents.
- Blinded evaluation of ultrasound images for quality criteria and overall evaluability.
Main Results:
- No statistical difference in image quality or evaluability was found between manual fixation and Graf's technique.
- 225 out of 230 images were sonographically normal; only a few were excluded due to hip pathology or non-evaluability.
Conclusions:
- Manual fixation by parents is a viable alternative to Graf's technique for infant hip ultrasound screening in normal cases.
- Future research should investigate hip pathologies and infant/parent comfort during examinations.
Background:
In Middle Europe ultrasonography is the standard method used to screen for developmental dysplasia of the hip in infants. Our aim was to determine whether manual fixation of the child is equivalent to Graf's technique regarding image quality.
Methods:
This randomized trial was conducted at a free-standing general pediatric outpatient clinic in Vienna, Austria. Healthy infants in the 1st and between the 6th and 8th week of life with no hip malalignment were included. After randomization, Group 1 was examined using Graf's fixation device and participants in Group 2 were fixated on the examination couch by their parents. In a second step, all images underwent a blinded evaluation.
Results:
A total of 117 babies (Group 1: n = 62, Group 2: n = 54, excluded: n = 1) were examined and 230 images (Group 1: n = 122, Group 2: n = 108) were evaluated, of which 225 were sonographically normal. Two images, showing a type IIa right hip and a type IIa + left hip respectively, were excluded. One participant had to be excluded as the respective images showed two pathologic hip joints. Two images in Group 1 and three in Group 2 were not evaluable. No statistical association between image quality (11 quality criteria and overall evaluability) and fixation technique (0.12 ≤ p ≤ 1.0 or constant) was found.
Conclusions:
Considering sonographically normal hip joints, we found no evidence that manual fixation differed from Graf's technique regarding image quality. In future studies, hip pathologies should be included and discomfort of infants and parents during the examination should be addressed.
Trial Registration:
German Clinical Trials Register, ID: DRKS00015694 ), registered retrospectively on October 7th, 2018.