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Clinical Examination Findings Can Accurately Diagnose Developmental Dysplasia of The Hip-A Large, Single-Center
İzzet Özay Subaşı1, Enejd Veizi2, Şahin Çepni2
1Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, Erzincan 24100, Turkey.
Insights
Physical exams like limited hip abduction and asymmetric skin creases can help screen for developmental dysplasia of the hip (DDH). Combining these findings offers high accuracy for early detection in infants.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Neonatal Screening
Background:
- Developmental dysplasia of the hip (DDH) diagnosis relies on physical exam findings like limited hip abduction (LHA) and asymmetric skin creases (ASC).
- Early detection through infant screening is crucial, involving various medical professionals.
- The study aimed to correlate physical exam findings with ultrasound for DDH diagnosis.
Purpose of the Study:
- To determine the correlation between physical examination findings (LHA, ASCs, Ortolani, Barlow tests) and ultrasound results in diagnosing DDH.
- To assess the diagnostic utility of specific physical signs in identifying DDH.
Main Methods:
- A cohort of 968 infants underwent routine hip ultrasonography.
- Physical examinations were performed by an orthopedic surgeon blinded to ultrasound results.
- Data on asymmetric skin folds, limited abduction, and Ortolani/Barlow tests were recorded and analyzed against ultrasound findings.
Main Results:
- Out of 968 patients, 117 were diagnosed with DDH via ultrasonography.
- The combination of LHA and thigh/groin ASCs demonstrated high sensitivity (83.8%), specificity (70.2%), and negative predictive value (96.9%).
- Positive predictive values for these combined physical findings were relatively low (27.8%).
Conclusions:
- Asymmetric skin creases and limited hip abduction, when assessed together, are valuable screening tools for DDH.
- These physical findings exhibit high sensitivity, specificity, and negative predictive values, aiding in initial DDH screening.
- The combined physical examination can effectively support early identification of DDH.
Background:
Physical examination findings such as limited hip abduction (LHA), asymmetric skin creases (ASC), and a popping sensation in the hip facilitate the diagnosis of developmental dysplasia of the hip (DDH). Screening with a simple physical examination during the first weeks of infancy is important for early detection of the condition, and a wide range of medical professionals, including general practitioners, obstetricians, pediatricians, and orthopedic surgeons etc. are involved in this process. The aim of this study was to determine the correlation between easily recognizable physical examination findings such as LHA, thigh/groin ACSs, and Ortolani and Barlow tests with ultrasound findings for the diagnosis of DDH.
Methods:
This study included 968 patients undergoing routine hip ultrasonography between December 2012 and January 2015. All patients were examined by an experienced orthopedic surgeon who was not the physician who performed the ultrasound examination to exclude bias between physical examination findings and ultrasound findings. Asymmetric skin folds (thigh and groin), limited abduction, Barlow and Ortolani tests were recorded. The relationship between the physical examination findings, ultrasound findings, and developmental dysplasia was investigated.
Results:
Of the 968 patients, 523 were female (54%) and 445 were male. On ultrasonography examination, 117 patients were found to have DDH. The sensitivity, specificity and negative predictive values of patients who were found to have both LHA and thigh/groin ASCs in all three physical examinations were high (83.8%, 70.2%, and 96.9%, respectively) while positive predictive values were found to be low (27.8%).
Conclusion:
Asymmetric skin creases on the thigh and groin and limited hip abduction, when evaluated together, have high sensitivity and specificity with additional high negative predictive values and could help during the initial screening process of DDH.
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