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Prospective evaluation of newborn soft-tissue hip "clicks" with ultrasound
C D Bond1, W L Hennrikus, E D DellaMaggiore
1Naval Hospital, San Diego, California, USA.
Insights
Persistent hip clicks in infants after 3 months are often soft-tissue related, not indicative of hip instability. Ultrasound studies confirm normal hip development and stability in these cases.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Infant Musculoskeletal Development
Background:
- Persistent hip "clicks" in infants beyond 3 months can cause parental concern.
- Clinical hip stability assessments (Barlow, Ortolani maneuvers) may be normal despite palpable clicks.
- The etiology of these soft-tissue clicks requires further investigation.
Purpose of the Study:
- To investigate the relationship between persistent soft-tissue hip clicks and hip joint stability in infants.
- To evaluate the utility of ultrasound in differentiating soft-tissue clicks from pathological hip conditions.
Main Methods:
- Prospective study of 50 infants with persistent hip clicks after 3 months of age.
- Clinical examination including Barlow and Ortolani maneuvers.
- Static and dynamic ultrasonography to assess acetabular coverage and femoral head stability, measuring the alpha angle.
Main Results:
- All infants had stable hip examinations and normal alpha angles (average 63° uninvolved, 62° clicking hips).
- Acetabular coverage of the femoral head exceeded 50% in all studied hips.
- Dynamic ultrasound examinations revealed no signs of hip instability.
Conclusions:
- Soft-tissue hip clicks in infants, even when persistent beyond 3 months, are not associated with hip instability.
- Ultrasound findings in these cases are consistently normal, supporting a benign soft-tissue origin.
- This suggests a reassuring diagnosis for infants presenting with clicks but stable clinical examinations.
Abstract:
Fifty infants with soft-tissue hip "clicks" persisting after age 3 months were prospectively studied by using ultrasound. All children demonstrated a stable hip examination by Barlow and Ortolani maneuvers; however, a click was palpated with abduction and adduction of the hip. Static ultrasonography demonstrated an average alpha angle of 63 degrees in uninvolved hips and 62 degrees in the clicking hips. All hips had > 50% femoral-head coverage by the acetabulum. Dynamic ultrasound examination was normal in all cases. The soft-tissue clicks were not related to instability in this series of 50 infants.