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Paediatric hip ultrasound: uncertainties in examination and choice of treatment
Florian Bucher1, Christian Görg2, Stefanie Weber3
1Orthopaedics and Trauma Surgery, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Hessen, Germany.
Insights
Routine newborn hip ultrasound screenings in Germany show significant quality deficits. Many referred infants have normal hips, indicating a need for improved Graf method training for physicians to reduce unnecessary treatments.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Neonatal Care
Background:
- Neonates in Germany routinely receive hip sonography via the Graf method during U3 screening.
- Referrals to specialized orthopedic departments occur when uncertainties arise during screening.
Purpose of the Study:
- To evaluate the quality of Graf method hip sonography in the outpatient setting.
- To assess the treatment needs of neonates referred for hip abnormalities.
Main Methods:
- Retrospective analysis of 384 neonate patient records.
- Data collected from consultations between April 2016 and April 2019.
Main Results:
- 74% of neonates had normal hip types (Ia/b).
- 32% required treatment (brace or cast), with longer duration for older infants.
- 64% of referred cases lacked confirmed developmental dysplasia of the hip upon control examination.
Conclusions:
- Deficits exist in performing and interpreting the Graf ultrasound method.
- A high rate of false positives (64%) was observed in referred cases.
- Enhanced training in hip anatomy and Graf method is recommended to improve screening accuracy.
Purpose:
In Germany, neonates undergo hip sonography examination using the Graf method during the routine U3 screening examination, performed by consultant physicians four to five weeks after birth, and are referred to specialized orthopaedic departments if there are any uncertainties. This study evaluated the quality of sonographic screening in the outpatient sector and the treatment requirements of referred children.
Methods:
We performed a retrospective analysis of the patient data of 384 neonates collected in consultations performed between April 2016 and April 2019.
Results:
In total, 74% (n = 284) of neonates presented a hip type Ia/b. Treatment (abduction brace or Fettweis cast) was required in 32% (n = 122) of cases. The treatment duration was significantly correlated with age at first presentation (Pearson's r = 0.678; p = 0.001). The treatment duration for patients aged > 200 days old at first presentation was twice as long as those aged 100 days at first presentation. Patients with public health insurance require referral by a consultant. Developmental dysplasia of the hip as referral diagnosis could not be confirmed in control examination in 64% (n = 132) of cases. Of the public health insured children, 97% (n = 200) were referred through a consultant paediatrician.
Conclusion:
We identified deficits in performing and interpreting the Graf method of ultrasound examination. A total of 64% of referred pathological hips turned out to be physiological configurations in our control examination. The future goal should be to increase anatomical knowledge of the newborn hip and ensure the correct use of Graf ultrasound method. Advanced training courses are recommended and necessary.
Level Of Evidence:
IV.
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