The use of X-ray at 5 months in a selective screening programme for developmental dysplasia of the hip

Journal of Children's Orthopaedics - Tập 5 Số 3 - Trang 195-200 - 2011
K Price1,2,3, Rosemary Dove1,2,3, J. B. Hunter1,2,3
1(&) Specialty Registrar in Trauma and Orthopaedics, Nottingham University Hospital, 1 Bessemer Drive, Mansfield, Nottinghamshire NG18 4FY, UK
2Associate Specialist in Paediatrics, Nottingham University Hospital, Derby Road, Nottingham NG7 2UH, UK
3Consultant in Paediatric Orthopaedics, Nottingham University Hospital, Derby Road, Nottingham NG7 2UH, UK

Tóm tắt

Background The methods used for any screening programme for developmental dysplasia of the hip (DDH) can be controversial. This was an opportunistic audit of our selective ultrasound screening programme using an X-ray at 5 months to prevent inappropriate discharge due to the learning curve of ultrasound. Methods Between 1990 and 2004 in Nottingham, UK, out of a total population of 108,500 births, approximately 11,500 neonates were screened using ultrasound. Any child with an ultrasound scan showing Graf α-angles greater than 60° (Graf Type I) with the hip in joint were discharged from the clinic. All of those discharged were subsequently X-rayed at 5 months in order to cover the learning curve of ultrasound. The X-rays were reviewed by a consultant radiologist and referred back to orthopaedics if there was lateralisation of the femoral head or an acetabular index above 30°. Results Of approximately 11,000 X-rays performed, only 53 patients were referred back to orthopaedics, of which 47 had a complete data set. Of these 47 children, only 8 (17%) required intervention. On review of the original ultrasounds, Graf's α-angle did not seem to correlate well with the need for intervention, as all were Type I hips. The femoral head cover (FHC) appeared to be more predictive of the need for treatment. There have been no late presentations to our unit of DDH following a normal 5-month X-ray. Conclusions We now check the Graf α-angle, FHC and dynamic stability in the ultrasound assessment and only perform X-ray at 5 months if there was a low α-angle or low FHC. Since this change, there have been no late presentations of DDH from the population screened by ultrasound.

Từ khóa


Tài liệu tham khảo

Ortolani M, 1937, Pediatria, 45, 129

10.1302/0301-620X.44B2.292

10.1097/01241398-199505000-00012

10.1007/s00264-007-0333-x

10.1302/0301-620X.87B9.16565

10.1097/00008480-199502000-00015

10.1186/1472-6920-5-17

10.1097/00003086-199208000-00011

10.1097/00008480-199502000-00014

10.1007/s11999-008-0119-5

10.1016/S0140-6736(02)12024-1

10.1302/0301-620X.79B5.7678

10.1097/01241398-199511000-00002

10.1097/01241398-200205000-00013

10.1542/peds.2005-1597

10.1136/adc.2003.029496

10.1097/01241398-199911000-00013

10.1302/0301-620X.76B4.8027134

10.1302/0301-620X.84B6.12093

10.1097/01241398-199911000-00012

10.2106/JBJS.D.01997

10.1136/adc.87.1.6

10.1007/BF00450934

10.1302/0301-620X.88B1.16419

10.1097/01241398-199409000-00022

10.1302/0301-620X.72B2.2179221

Graf R, 1987, Guide to sonography of the infant hip

10.1148/radiology.157.3.3903854

10.1302/0301-620X.88B9.17330

[No authors listed] (1992) Conclusions of Consensus Conference on the screening or congenital hip dislocation. Paris, 4 November 1991. Arch Fr Pediatr 49(2):145–146

Thông tin
Thông tin xuất bản

Journal of Children's Orthopaedics

Tập 5 Số 3

195-200

Thông tin tác giả