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[Congenital hip dislocation. Ultrasonic screening of newborn infants]
K Rosendahl1, R T Lie, T Markestad
1Røntgenavdelingen Barneradiologisk seksjon Haukeland Sykehus, Bergen.
Insights
Ultrasound screening effectively assesses hip morphology and stability in newborns. Universal screening may reduce late diagnoses of congenital dislocation of the hip (CDH).
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
Background:
- Congenital dislocation of the hip (CDH) remains a concern despite early detection efforts.
- Ultrasound offers a reliable method for evaluating infant hip morphology and stability.
Purpose of the Study:
- To assess the utility of ultrasound in evaluating hip morphology and stability in newborns.
- To determine the prevalence of hip abnormalities in the Norwegian newborn population.
Main Methods:
- Utilizing Graf's method for coronal ultrasound assessment of acetabular morphology (alpha-angle).
- Employing a Barlow-equivalent provocation test to evaluate hip stability.
- Classifying hips based on alpha-angle measurements and femoral head coverage.
Main Results:
- Approximately 85% of Norwegian newborns exhibit normal hip morphology (alpha-angle).
- 12% of newborns present with immature hips, and 3% have dysplastic hips.
- A significant portion of dysplastic hips show minor changes and may resolve spontaneously.
Conclusions:
- Ultrasound is a valuable tool for assessing infant hip development and stability.
- Universal ultrasound screening holds potential for reducing late-diagnosed cases of congenital hip dislocation.
Abstract:
Despite the introduction of clinical screening and early treatment of congenital dislocation of the hip (CDH), the prevalence of subluxated/luxated hips in later infancy is still reported to be as high as 1-3 per 1,000 infants. Using ultrasound, it is possible to evaluate both hip morphology and hip stability. Hip morphology is best evaluated using Graf's coronal section through the deepest part of the acetabulum. Classification of the hips into different categories can then be based on measuring the angle of inclination of the acetabulum (alpha-angle) or femoral had coverage. Hip stability can be assessed by a Barlow-equivalent provocation test during the ultrasound examination. In the Norwegian newborn population approximately 85% of the infants have morphologically normal hips (based on the alpha-angle) while 12% have immature and 3% dysplastic hips. About 80-90% of infants with dysplastic acetabula show only minor changes, and many of the hips may normalize without treatment. Several studies indicate that universal ultrasound screening might reduce the occurrence of late diagnosed congenital dislocation of the hip.