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Developmental Dysplasia of the Hip: Management from a Pediatrician Perspective
Anthony El Alam1, Joseph Mouawad1, Andrew Takchi2,3
1Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Beirut, Lebanon.
Insights
Lebanese pediatricians show significant gaps in Developmental Dysplasia of the Hip (DDH) screening knowledge and practices. Improved training and neonatal screening are crucial for early detection and better patient outcomes.
Area of Science:
- Pediatric Orthopedics
- Public Health
Background:
- Developmental Dysplasia of the Hip (DDH) is a prevalent congenital anomaly.
- Early diagnosis of DDH is critical to avoid invasive treatments.
Purpose of the Study:
- To evaluate Lebanese pediatricians' knowledge of DDH risk factors, screening, and treatment.
- To compare current practices with international guidelines.
- To propose improved screening recommendations for DDH in Lebanon.
Main Methods:
- Cross-sectional descriptive study utilizing confidential questionnaires.
- Data collected from 263 Lebanese pediatricians.
- Analysis of responses using proportion tests.
Main Results:
- A significant training gap in DDH screening was identified among Lebanese pediatricians.
- Most pediatricians did not adhere to recommended screening guidelines.
- Gaps noted in risk factor identification, physical exams, imaging, and treatment.
Conclusions:
- Urgent need for improved education and training on DDH screening and management.
- Implementing routine neonatal screening is essential to reduce delayed diagnoses.
- Addressing these gaps will improve early detection and patient outcomes for DDH.
Objectives:
Developmental Dysplasia of the Hip (DDH) is a common congenital anomaly requiring early diagnosis to minimize invasive treatments. This study evaluates Lebanese pediatricians' knowledge of DDH risk factors, screening methods, and treatment strategies, comparing their practices to American and European guidelines to propose screening recommendations.
Methods:
A cross-sectional descriptive study was conducted using a confidential questionnaire to assess Lebanese pediatricians' knowledge and practices regarding DDH. Contact information for pediatricians was obtained from the Lebanese Order of Physicians. Out of 600 emailed and 100 distributed questionnaires, 263 responses were received, and data were analyzed using proportion tests.
Results:
Of the 263 respondents (19.9% response rate), 84% routinely ordered radiographs at 4 months, while only 0.4% followed recommended guidelines. About 50% performed hip stability tests (Barlow and Ortolani) at 6 months, and 78.32% recommended the Pavlik harness for post-6-month treatment. Additionally, 97% valued periodic reminders about DDH. Significant gaps were identified in training on risk factor identification, physical examination procedures, imaging indications, management of abnormal findings, and treatment choices.
Conclusions:
The study highlights a critical training gap in DDH screening among Lebanese pediatricians. Implementing routine neonatal screening aligned with international recommendations is essential to reduce delayed diagnosis and its associated economic burden. Improved education and training on DDH screening and treatment are crucial for early detection and better patient outcomes.
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