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MRI in Postreduction Evaluation of Developmental Dysplasia of the Hip: Our Experience
Daniela Dibello1, Luca Odoni1, Federica Pederiva2
1Pediatric Orthopedics.
Insights
Magnetic resonance imaging (MRI) reliably confirms successful closed reduction for developmental dysplasia of the hip (DDH). This safe imaging technique accurately assesses femoral head position, ensuring optimal outcomes for infants with DDH.
Area of Science:
- Pediatric Orthopedics
- Medical Imaging
- Congenital Disorders
Background:
- Developmental dysplasia of the hip (DDH) is a common congenital defect in newborns.
- Severe, uncorrected DDH leads to significant long-term morbidity.
- Closed reduction with casting is the standard initial treatment for DDH.
Purpose of the Study:
- To evaluate the reliability of magnetic resonance imaging (MRI) in assessing the success of closed reduction for DDH.
- To determine MRI's effectiveness in confirming femoral head position post-reduction.
Main Methods:
- Retrospective review of children with Graf type IV DDH treated with closed reduction between 2010 and 2016.
- MRI was used to assess the postreduction position of the femoral head within 24 hours.
Main Results:
- Twenty-five patients (29 hips) with Graf type IV DDH underwent closed reduction at a mean age of 3.4 months.
- MRI confirmed concentric reduction in 24 out of 25 patients (96%).
- One patient required open reduction due to persistent hip instability; no sedation was needed for MRI.
Conclusions:
- MRI is an excellent, safe, and reliable imaging modality for assessing postreduction hip stability in DDH.
- MRI accurately confirms adequate femoral head positioning and detects soft tissue interposition.
- MRI is considered the gold standard for early detection of dislocation after closed reduction of DDH.
Background:
Developmental dysplasia of the hip (DDH) is one of the most common congenital defects in the newborn. When its severe form is not corrected, it is associated with long-term morbidity. Closed reduction with casting is the standard primary treatment and reduction is confirmed by magnetic resonance imaging (MRI). We reported our experience on the reliability of MRI in postreduction assessment of DDH.
Methods:
All children who underwent closed reduction for Graf type IV DDH at our institution between September 2010 and June 2016 were retrospectively reviewed. Since 2010 we assessed postreduction position of the femoral head by performing a MRI.
Results:
Twenty-five (5 male, 20 female) patients presented with 29 (15 left sided, 6 right sided, 4 bilateral) Graf type IV DDH and underwent closed reduction at a mean age of 3.4 months. In all patients MRI studies performed within 24 hours were diagnostic, showing a concentric reduction of the femoral head within the acetabulum in 24/25 patients. In the patient with persistent hip instability, a subsequent open reduction was performed. In all the cases, there was no need of any contention or sedation during MRI.
Conclusions:
On the basis of our experience, MRI is an excellent, safe and, reliable modality to confirm maintenance of adequate femoral head position and to evaluate soft tissue interposition. We agree that MRI is the gold standard to early depict dislocation after closed reduction of DDH.
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