1
|
Almutairi FF. Incidence and characteristics of developmental dysplasia of the hip in a Saudi population: A comprehensive retrospective analysis. Medicine (Baltimore) 2024; 103:e36872. [PMID: 38335415 PMCID: PMC10860996 DOI: 10.1097/md.0000000000036872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 02/12/2024] Open
Abstract
Developmental dysplasia of the hip (DDH) is a common hip disorder in infants. Ultrasonographic screening is considered the most reliable method for early detection of DDH in newborn infants. This study aimed to determine the incidence of DDH at King Abdulaziz University Hospital. From January 2017 to December 2018, this retrospective study analyzed the data of 8031 infants who underwent an early clinical examination of the hips. At the initial evaluation, 212 infants referred to the ultrasound department had risk factors for DDH and/or clinical instability. Different well-known risk factors of DDH have been identified including breech position, skeletal deformities, positive family history, hip side, sex and clicky hip. The findings revealed an incidence rate of 93 cases of DDH among 8031 infants (11.58 per 1000) births. Among the infants diagnosed with DDH, 55 were females (59.14 %), and 38 were males (40.86%). The results of the current study revealed that 45% of infants with DDH exhibited bilateral involvement. Moreover, results showed that the IIa hip joint was more prevalent in female than in male newborns, but without any significant difference. The incidence rate of DDH in this study was 11.58 per 1000 live births, and it was more prevalent among female than male newborns. Ultrasonography (US) should be used as a complementary imaging modality for clinical examination of DDH. Infants with breech presentation, clicky hip, and skeletal deformity should be scanned by US. Further prospective studies are recommended.
Collapse
Affiliation(s)
- Fahad F. Almutairi
- Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Animal House Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, Saudi Arabia
- Smart Medical Imaging Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
- Medical Imaging and Artificial Intelligence Research Unit, Center of Modern Mathematical Sciences and its Applications, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
2
|
Walton TJ, Chatterton BD, Dover C, Kiely NT. Dislocation of the hip after normal sonographic screening examination: a case report and literature review. Ann R Coll Surg Engl 2022; 104:e187-e189. [PMID: 35174714 PMCID: PMC9158071 DOI: 10.1308/rcsann.2021.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report the case of a five-month-old girl presenting with a subluxed left hip following normal neonatal clinical examination and serial ultrasound screening. Her only risk factor for developmental dysplasia of the hip (DDH) was breech presentation. She underwent closed reduction with successful concentric reduction. This case demonstrates that hip subluxation can occur after normal ultrasound screening, and has important clinical and medicolegal implications. Consideration should be given to further follow-up in children with overt risk factors for DDH, even after normal ultrasound examination.
Collapse
Affiliation(s)
- TJ Walton
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, UK
| | - BD Chatterton
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
| | - C Dover
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
| | - NT Kiely
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK
| |
Collapse
|
3
|
Koşar PN, Ergün E, Gökharman D. Can Medialization of Acetabular Rim Be a Prognostic Factor in Treatment of Developmental Dysplasia of Hip? J Ultrasound Med 2022; 41:645-652. [PMID: 34008885 DOI: 10.1002/jum.15745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate if acetabular rim medialization (ARM) can be used as a new parameter in determining the treatment choice and duration in Graf type III and IV hips. METHODS Among the 12,300 infants who underwent hip ultrasound (US) according to Graf's method between 2015 and 2019, 26 infants (9 had bilateral pathology hence 35 hips) with type III and IV hips, whose follow-up data could be obtained were included in the study. Age of the infants at the initial diagnosis, ARM measurement, the duration of harness treatment, and the treatment results were noted. To determine the extent of ARM, distance between a line that is drawn tangential to the iliac wing and acetabular rim was measured. RESULTS In cases with poor prognosis, ARM measurement was 6 to 8.5 mm on the right hip and 4 to 9 mm on the left hip. Bilaterality or unilaterality, left or right pathology, and gender did not have a significant effect on the prognosis (P >.05). Age at the initial diagnosis and ARM had significant effects on treatment success (P = .04, P = .00, respectively). In predicting the prognosis, ARM was found to be more successful than age (AUC = 0.95 versus AUC = 0.68). When these two variables were evaluated together, the success in predicting the prognosis significantly increased (AUC = 0.98). CONCLUSIONS ARM measurement may have an important role in determining the treatment method and duration in Graf type III and IV hips. It can be used as a prognostic factor alone or in combination with treatment initiation time. When the two factors are combined, prognostic value significantly increases.
Collapse
Affiliation(s)
- Pınar Nercis Koşar
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Elif Ergün
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Dilek Gökharman
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
4
|
Djoleva T, Matveeva N, Georgieva D, Bojadzieva S. Outcomes of ultrasound-monitored treatment of divelopmental dysplasia of the hip graf type II. Sanamed 2022. [DOI: 10.5937/sanamed0-40197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction: The management of developmental dysplasia of the hips (DDH) type Graf IIa is still controversial. This study aims to examine the outcomes of ultrasound-monitored Pavlik harness treatment, as well as the effects of associated factors, such as gender, side of DDH, the age at the treatment start, and laterality on the treatment outcomes in different Graf type II subtypes. Methods: A cohort retrospective investigation was performed on 88 ultrasound-screened infants or 125 hips diagnosed with Graf type II dysplasia during a six-month period at a single institution, the University Clinic for Orthopedic Surgery, Skopje. Subsequently, 47 infants (18 boys, 29 girls) or 73 hips who underwent Pavlik harness treatment with at least one follow-up throughout treatment monitoring were included in this study. Results: The treatment success rate of the right DDH Graf type IIa (-) was higher (70.8%) compared to the rate of success (50%) in the treatment of left Graf type IIa (-) hips. The mean age of the infants at the treatment start in successfully treated Graf type IIa (-) hips was lower (9.12 ± 2.27 weeks) compared to the age of the infants with treatment failure at the last follow-up (11.33 ± 3.06 weeks), P = 0.04. Conclusion: The age of treatment initiation and the side of DDH were the most relevant factors related to the treatment outcome. Infants with maturational deficit hips, Graf type IIa (-), should undergo early initiated, carefully guided, and monitored Pavlik harness treatment.
Collapse
|
5
|
TOPAK D, DOĞAN K, ÖZDEMİR MA, KUŞÇU B, TEMİZ A, BİLAL Ö. Graf Tip 2a kalçalarda sonografik bozulma ile ilişkili faktörlerin incelenmesi. Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi 2021. [DOI: 10.17517/ksutfd.1000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
6
|
Ulziibat M, Munkhuu B, Bataa AE, Schmid R, Baumann T, Essig S. Traditional Mongolian swaddling and developmental dysplasia of the hip: a randomized controlled trial. BMC Pediatr 2021; 21:450. [PMID: 34641800 PMCID: PMC8513275 DOI: 10.1186/s12887-021-02910-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mongolian traditional swaddling of infants, where arms and legs are extended with a tight wrapping and hips are in adduction position, may lead to abnormal maturation and formation of the hip joint; and is a contributing factor for developmental dysplasia of the hip (DDH). This hypothesis was tested in this randomized controlled trial. METHODS Eighty newborns with one or two hips at risk of worsening to DDH (Graf Type 2a; physiologically immature hips) at birth were randomized into 2 groups at a tertiary hospital in Ulaanbaatar. The "swaddling" group (n = 40) was swaddled in the common traditional Mongolian method for a month while the "non-swaddling" group (n = 40) was instructed not to swaddle at all. All enrollees were followed up on monthly basis by hip ultrasound and treated with an abduction-flexion splint if necessary. The groups were compared on the rate of Graf's "non-Type 1" hips at follow-up controls as the primary outcome. Secondary outcomes were rate of DDH and time to discharge (Graf Type 1; healthy hips). In addition, correlation between the primary outcome and swaddling length in days and frequency of swaddling in hours per day were calculated. RESULTS Recruitment continued from September 2019 to March 2020 and follow-up data were completed in June 2020. We collected final outcome data in all 80 enrollees. Percentages of cases with non-Type 1 hip at any follow-up examination were 7.5% (3/40) in the non-swaddling group and 40% (16/40) in the swaddling group (p = 0.001). There was no DDH case in the non-swaddling group while there were 8 cases of DDH in the swaddling group. The mean time to discharge was 5.1 ± 0.3 weeks in the non-swaddling group and 8.4 ± 0.89 weeks in the swaddling group (p = 0.001). There is a correlation between the primary outcome and the swaddling frequency in hours per day (r = 0.81) and swaddling length in days (r = 0.43). CONCLUSIONS Mongolian traditional swaddling where legs are extended and hips are in extension and adduction position increases the risk for DDH. TRIAL REGISTRATION Retrospectively registered, ISRCTN11228572 .
Collapse
Affiliation(s)
- Munkhtulga Ulziibat
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland.
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia.
| | - Bayalag Munkhuu
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | | | | | | | - Stefan Essig
- Center for Primary and Community Care, Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| |
Collapse
|
7
|
Gokharman FD, Aydin S, Fatihoglu E, Ergun E, Kosar PN. Optimizing the Time for Developmental Dysplasia of the Hip Screening: Earlier or Later? Ultrasound Q 2019; 35:130-5. [PMID: 29509577 DOI: 10.1097/RUQ.0000000000000348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Developmental dysplasia of the hip (DDH) is still a common and important disorder of childhood, with a prevalence of 0.1 to 2/1000 children. Using ultrasonography (US) in screening of DDH reduces the rates of open reductions and complications. In the current study, we aim to detect the optimal time for US examination for detecting DDH to prevent unnecessary repeating US examinations and treatments. METHODS Children referred to US examination for a healthy child screening program, according to the health policy of our country, are included in the current prospective study. Both hips of each child were sonographically examined by the same radiologist using Graf's method at 4th, 8th, 12th weeks of life. RESULTS A total of 2020 hips of 1010 children were examined. Fourth-week US results can predict 12th-week results (right hip: sensitivity 100%, specificity 75.7%; left hip: sensitivity 100%, specificity 78.3%). Eighth-week US results can predict 12th-week results (right hip: sensitivity 100%, specificity 87.5%; left hip: sensitivity 100%, specificity 83.9%). In predicting 12th-week US results, 8th-week results are found to be more successful than 4th-week results. CONCLUSIONS Late diagnosis of DDH might cause serious public health problems. On the other hand, early US examinations can result in false-positive diagnosis. Unfortunately, there is still confusion about the optimal time for DDH screening with US, especially among radiologists who are not specialized in DDH sonography. A US scan performed at eighth week of life can predict any pathology presence safely and correctly.
Collapse
|
8
|
Biedermann R, Riccabona J, Giesinger JM, Brunner A, Liebensteiner M, Wansch J, Dammerer D, Nogler M. Results of universal ultrasound screening for developmental dysplasia of the hip: a prospective follow-up of 28 092 consecutive infants. Bone Joint J 2018; 100-B:1399-1404. [PMID: 30295526 DOI: 10.1302/0301-620x.100b10.bjj-2017-1539.r2] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The purpose of this study was to analyze the incidence of the different ultrasound phenotypes of developmental dysplasia of the hip (DDH), and to determine their subsequent course. PATIENTS AND METHODS A consecutive series of 28 092 neonates was screened and classified according to the Graf method as part of a nationwide surveillance programme, and then followed prospectively. Abnormal hips were followed until they became normal (Graf type I). Type IIb hips and higher grades were treated by abduction in a Tübinger orthosis until normal. Dislocated hips underwent closed or open reduction. RESULTS Overall, 90.2% of hips were normal at birth. Type IIa hips (8.9%) became normal at a median of six weeks (interquartile range (IQR) 6 to 9). Type IIc and IId hips (0.67%) became normal after ten weeks (IQR 7 to 13). There were 19 type lll and eight type lV hips at baseline. There were 24 closed reductions and one open reduction. No late presentations of DDH were detected within the first five years of life. CONCLUSION The incidence of DDH was eight per 1000 live births. The treatment rate was 1% (n = 273). The rate of first operations on the newborn hip was 0.86, and rate of open surgery was 0.04. The cumulative rate of open surgery was 0.07. The authors take the view that early identification and treatment in abduction of all dysplastic hips in early childhood reduces the rate of open reduction and secondary DDH-related surgery later in life. Cite this article: Bone Joint J 2018;100-B:1399-1404.
Collapse
Affiliation(s)
- R Biedermann
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - J Riccabona
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - J M Giesinger
- Innsbruck Institute of Patient-Centered Outcome Research (IIPCOR), Innsbruck, Austria
| | - A Brunner
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - M Liebensteiner
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - J Wansch
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - D Dammerer
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| | - M Nogler
- Department of Orthopaedics, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
9
|
Abstract
Background: The rate of spontaneous normalization in type IIa hips is reported to be high, whereas dysplsia persists or worsens in 5%-10% of cases. Aims: To evaluate the natural course of type IIa hips using Graf’s own perspective of physiological immaturity and maturational deficit. Study Design: A single center, retrospective cohort study. Methods: This was an institutional review board-approved retrospective review of all patients diagnosed with type IIa hip dysplasia at a single institution from 2012 to 2014. All patients included in the study had hip ultrasonography at about 6 weeks and 3 months of age. To assess reliability in α and β angles, ultrasonography measurements were carried out on the same image individually by all observers. The α and β angles were used as the main outcome measurements to evaluate hip maturation at the last follow-up. A receiver operating characteristics curve was drawn at the 3 month ultrasonography to evaluate the cut-off values for α and β angles for persistent dysplasia. Results: Sixty-four patients and 88 affected hips (63% unilateral and 37% bilateral) were included. The mean age at diagnosis was 6.4±2.7 weeks. Fifty-four hips were type IIa(+) (physiologically immature) and 34 hips were type IIa(-) (maturational deficit) at the initial ultrasonography evaluation. Improvement to type I was seen in 52 type IIa(+) and 17 type IIa(-) hips. Receiver operating characteristic analyses showed that patients do well if the α angle was >55° (area under the curve: 0.86; p<0.001 for the left hip and area under the curve: 0.72; p=0.008 for the right hip). Conclusion: The cut-off α angle value of 55° on initial ultrasonography should be considered to prevent future dysplasia. An α angle <55° on the initial ultrasonography was an independent predictor of worsening sonographic findings.
Collapse
Affiliation(s)
- Fuat Bilgili
- Department of Orthopedics and Traumatology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Yavuz Sağlam
- Department of Orthopedics and Traumatology, Biruni University School of Medicine, İstanbul, Turkey
| | - Süleyman Bora Göksan
- Department of Orthopedics and Traumatology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Önder Murat Hürmeydan
- Department of Orthopedics and Traumatology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Fevzi Birişik
- Department of Orthopedics and Traumatology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Mehmet Demirel
- Department of Orthopedics and Traumatology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| |
Collapse
|
10
|
Zonoobi D, Hareendranathan A, Mostofi E, Mabee M, Pasha S, Cobzas D, Rao P, Dulai SK, Kapur J, Jaremko JL. Developmental Hip Dysplasia Diagnosis at Three-dimensional US: A Multicenter Study. Radiology 2018; 287:1003-1015. [DOI: 10.1148/radiol.2018172592] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
11
|
Lee J, Spinazzola RM, Kohn N, Perrin M, Milanaik RL. Sonographic screening for developmental dysplasia of the hip in preterm breech infants: do current guidelines address the specific needs of premature infants? J Perinatol 2016; 36:552-6. [PMID: 26914014 DOI: 10.1038/jp.2016.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 01/08/2016] [Accepted: 01/12/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the association between gestational age versus corrected age at the time of hip ultrasound with findings for developmental dysplasia of the hip (DDH) in preterm breech infants. STUDY DESIGN A retrospective medical chart review was conducted to examine hip ultrasounds of 318 premature breech infants for findings associated with DDH. RESULTS Positive findings for DDH occurred in 3/135 (2%) of infants <32 weeks gestational age and 17/183 (9%) of infants 32 to <37 weeks gestational age (odds ratio: 0.22, 95% CI: 0.04 to 0.79, P<0.015). No infants born <32 weeks gestational age had abnormal findings for DDH upon follow-up ultrasound. Infants <40 weeks corrected age at the time of hip ultrasound were more likely to have DDH findings compared with infants ⩾44 weeks corrected age (odds ratio: 7.83, 95% CI: 2.20 to 29.65, P<0.001). CONCLUSION Current hip ultrasonography policies that include screening of premature breech infants may need to be revised.
Collapse
Affiliation(s)
- J Lee
- Cohen Children's Medical Center of New York, Lake Success, NY, USA
| | - R M Spinazzola
- Cohen Children's Medical Center of New York, Lake Success, NY, USA
| | - N Kohn
- The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - M Perrin
- Cohen Children's Medical Center of New York, Lake Success, NY, USA
| | - R L Milanaik
- Cohen Children's Medical Center of New York, Lake Success, NY, USA
| |
Collapse
|
12
|
Brinsmead T, Hong T, Frawley K. A case of late presentation of developmental dysplasia of the hip with normal screening ultrasound scan. J Paediatr Child Health 2014; 50:494. [PMID: 24888305 DOI: 10.1111/jpc.12589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tammy Brinsmead
- Department of Paediatrics, Gold Coast Hospital, Gold Coast, Queensland, Australia
| | | | | |
Collapse
|
13
|
Munkhuu B, Essig S, Renchinnyam E, Schmid R, Wilhelm C, Bohlius J, Chuluunbaatar B, Shonkhuuz E, Baumann T. Incidence and treatment of developmental hip dysplasia in Mongolia: a prospective cohort study. PLoS One 2013; 8:e79427. [PMID: 24205385 PMCID: PMC3812003 DOI: 10.1371/journal.pone.0079427] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 09/24/2013] [Indexed: 11/18/2022] Open
Abstract
Background In Mongolia, adequate early diagnosis and treatment of developmental hip dysplasia (DDH) have been unavailable and its incidence was unknown. We determined the incidence of ultrasonographic DDH in newborns and established adequate procedures for diagnosis and treatment of DDH at the largest maternity hospital in Ulaanbaatar, Mongolia. Methodology/Principal Findings During one year (Sept 2010 – Aug 2011) we assessed the hips newborns using ultrasound and Graf’s classification of DDH. 8,356 newborns were screened; median age at screening was 1 day. We identified 14,873 Type 1 (89.0%), 1715 Type 2a (10.3%), 36 Type 2c (0.2%), 70 Type D (0.4%), 14 Type 3 (0.08%), and 4 Type 4 hips (0.02%). Children with Type 1 hips (normal) were discharged. Children with Type 2a hips (physiologically immature) received follow-up ultrasounds at monthly intervals. Children with Type 2c to 4 (DDH; deformed or misaligned hip joint) hips were treated with a Tubingen hip flexion splint and also followed up. The hip abnormalities resolved to mature hips in all children who were followed up. There was no evidence for severe treatment related complications. Conclusion/Significance This study suggests that the incidence of DDH in Mongolian neonates is comparable to that in neonates in Europe. Early ultrasound-based assessment and splinting treatment of DDH led to mature hips in all children followed up. Procedures are feasible and will be continued.
Collapse
Affiliation(s)
- Bayalag Munkhuu
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - Stefan Essig
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | | | | | - Julia Bohlius
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - Enkhtur Shonkhuuz
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - Thomas Baumann
- Zentrum für körper- und sinnesbehinderte Kinder, Solothurn, Switzerland
- * E-mail:
| |
Collapse
|
14
|
Ömeroğlu H, Çaylak R, İnan U, Köse N. Ultrasonographic Graf type IIa hip needs more consideration in newborn girls. J Child Orthop 2013; 7:95-8. [PMID: 24432065 PMCID: PMC3593017 DOI: 10.1007/s11832-012-0476-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/17/2012] [Indexed: 02/03/2023] Open
Abstract
PURPOSE According to hip ultrasonography by Graf's method, the type IIa hip has a certain degree of physiological delay in ossification of the bony acetabular roof. The aim of this case-control study was to evaluate the natural history of the type IIa hip. METHODS Four hundred and thirty-one type IIa hips were identified in 312 of 1,690 ultrasonographically screened newborns with a mean age of 27 days. Parents were accurately informed about the prognosis of such a hip condition and invited for ultrasonographic re-examination at 6-7 weeks of age. RESULTS Type IIa hip was more common in newborn girls than in boys (P < 0.001). Among 431 type IIa hips, 146 (34 %) missed the follow-up examination at 6-7 weeks of age. Among the completely followed 285 hips, 225 (79 %) developed into a normal hip at 6-7 weeks of age. Newborn boys' hips had a higher rate of spontaneous normalization than girls' hips at 6-7 weeks of age (P = 0.006). All but one type IIa(+) hip became type I without any treatment. According to our management protocol, 35 type IIa(-) hips and one type IIa(+) hip, which later became type IIb, underwent treatment. The rate of treatment was higher in newborn girls' hips than in boys' hips (P = 0.019). CONCLUSIONS As Graf type IIa hip is more common, has a lower rate of spontaneous normalization and higher rate of treatment in newborn girls than in boys, we recommend paying more attention the type IIa hip in newborn girls. The rate of missing the required follow-up is unacceptably high due to parents' insensitivity regarding the type IIa hip.
Collapse
Affiliation(s)
- Hakan Ömeroğlu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Eskişehir Osmangazi University, 26480 Eskişehir, Turkey
| | - Remzi Çaylak
- Department of Orthopaedics and Traumatology, Private Ortopedia Hospital, Adana, Turkey
| | - Ulukan İnan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Eskişehir Osmangazi University, 26480 Eskişehir, Turkey
| | - Nusret Köse
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Eskişehir Osmangazi University, 26480 Eskişehir, Turkey
| |
Collapse
|