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[Roentgen studies and arthrography of the hip joint in infancy]
1Orthopädische Klinik, Städtische Kliniken Dortmund.
Insights
Radiographic hip exams aid in diagnosing infant hip dysplasia and Perthes disease when ultrasound is insufficient. Close monitoring of critical values is essential for tracking dysplasia progression and guiding treatment decisions.
Area of Science:
- Pediatric Orthopedics
- Diagnostic Imaging
- Radiology
Background:
- Radiographic hip examinations remain valuable adjuncts to sonography in infant hip assessment.
- Proper patient positioning (neutral legs, stable pelvis) is crucial for accurate radiographic interpretation.
Purpose of the Study:
- To outline the indications and techniques for radiographic hip evaluation in infants.
- To emphasize the diagnostic utility of specific radiographic views and indices in hip dysplasia and Perthes disease.
Main Methods:
- Utilized Hilgenreiner's acetabular index for diagnosing hip dysplasia.
- Recommended axial orthograde hip views for precise Catterall grouping in Perthes disease.
- Indicated arthrography for irreducible dislocated hips with cartilaginous inlet narrowing.
Main Results:
- Long-term follow-up revealed spontaneous improvement in some hip dysplasia cases, while others showed progression.
- Critical values (1-2 standard deviations above the mean) require careful monitoring.
- Axial orthograde views offer superior Catterall group determination compared to the Lauenstein position for Perthes disease.
Conclusions:
- Radiography plays a complementary role to ultrasound in infant hip assessment.
- Accurate radiographic technique and interpretation are vital for managing hip dysplasia and Perthes disease.
- Arthrography is essential for specific cases of hip dislocation, highlighting the risk of avascular necrosis and the need for traction.
Abstract:
Radiographic examination of infants' hips is still indicated sometimes in addition to the sonographic examination. The legs have to be kept in a neutral position. The pelvis should not be turned to the side or tilted. Hilgenreiner's acetabular index is preferred in the diagnosis of hip dysplasia. Long-term follow-ups of critical values show spontaneous improvement in some cases, but also joints with increasing dysplasia. Critical values between one and two standard deviations of our material and somewhat above have to be followed. The axial orthograde view of the hip as a lateral view of the femoral head is recommended in Perthes' disease to determine the Catterall groups more exactly than in the Lauenstein position. Arthrography is still indicated in dislocated hips that cannot be reduced into the socket because of a narrow cartilaginous inlet. Here the risk of avascular necrosis is high and traction is indicated.