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Developmental dysplasia of the hip: Beyond the screening. Physical exam is our pending subject
Carla Escribano García1, Luis Bachiller Carnicero1, Sara Isabel Marín Urueña1
1Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain.
Insights
Developmental dysplasia of the hip requires early detection. While screening protocols aid diagnosis, clinical examination is crucial for identifying cases without risk factors, yet ultrasound use appears excessive.
Area of Science:
- Pediatric Orthopedics
- Medical Imaging
- Developmental Pediatrics
Background:
- Developmental dysplasia of the hip (DDH) is a significant cause of childhood disability.
- Early DDH detection improves patient prognosis.
- While risk factors exist, many DDH cases lack them, underscoring the importance of physical examination.
Purpose of the Study:
- To evaluate the effectiveness of screening protocols for developmental dysplasia of the hip.
- To assess the correlation between risk factors, clinical examination, and ultrasound diagnosis of DDH.
- To analyze the utilization and efficiency of hip ultrasounds in a pediatric cohort.
Main Methods:
- Retrospective cohort study design.
- Inclusion of infants undergoing hip ultrasound at a tertiary care center.
- Analysis of diagnosed DDH cases, identified risk factors, and requested ultrasounds during the study period.
Main Results:
- 530 hip ultrasounds were performed on 456 newborns.
- Only 3 out of 12 diagnosed hip dysplasias were associated with identified risk factors.
- The majority of DDH cases were detected via clinical examination, not solely risk factor screening.
Conclusions:
- Clinical examination remains vital for diagnosing developmental dysplasia of the hip, especially in infants without typical risk factors.
- Current screening protocols may lead to an overutilization of hip ultrasounds.
- Balancing screening protocols with clinical assessment is necessary for efficient DDH detection.
Introduction:
Developmental dysplasia of the hip is a common cause of disability among children. Early detection leads to better prognosis. There are some risk factors that increase the possibility of developing a dysplasia. But not every child with developmental dysplasia has them. This means that physical examination is still very useful to detect them. However, based on clinical findings, the amount of requested ultrasound seems higher than it would be necessary.
Methods:
Retrospective cohort study of infants born in a single tertiary care centre. Babies in which hip ultrasound was performed were included. During the period of study, patients with diagnosis of developmental hip dysplasia were also included, as well as the amount of ultrasounds requested during this period, and their efficiency.
Results:
Out of the 456 newborns included, 530 hip ultrasounds were performed. Just 3 of the total 12 dysplasias had risk factors. The others were diagnosed through clinical examination.
Conclusions:
Screening protocols are useful to detect hip dysplasia but clinical examination is very important to detect those cases without risk factors. However, the number of tests is higher than expected according to the diagnosed dysplasias.
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