Ultrasonography is the ideal tool for assessing hip morphology in infants younger than 6-month-old. This study assessed the interobserver agreement and clinical disparities of the 2 most widely used ultrasound (US) methods, the Graf method, and femoral head coverage (FHC) measurement. A prospective observational study (STROBE compliant) of 2024 newborns was conducted between January 2017 and December 2018. Hip US was conducted on all newborns with abnormal Barlow and Ortolani maneuvers as well as on 50 randomly selected normal newborns. The physical examination and US were performed by a senior pediatric orthopedic surgeon with musculoskeletal sonography certification. Three observers with different levels of experience interpreted the images by using the Graf method and FHC. We analyzed the intraclass correlation coefficient, Cohen kappa, and the disparity between the clinical findings of the 2 methods. A total of 198 newborns (9.8%) presented with clinical instability, including 193 subluxatable hips in 168 patients (84.8%) and 45 dislocatable/dislocated hips in 30 patients (15.2%). The mean age at US examination was 11.69 days (range: 0–18 days). The intraclass correlation coefficient was .71 (95% CI: 0.55–0.83) for FHC, 0.63 (95% CI: 0.38–0.78) for the alpha angle, and 0.47 (95% CI: 0.16–0.69) for beta angle. The Cohen kappa coefficients of Graf type were 0.19 (95% CI: 0.03–0.35), 0.39 (95% CI: 0.20–0.58), and 0.17 (95% CI: 0.02–0.32) between observers 1 and 2, observers 1 and 3, and observers 2 and 3, respectively. Based on the Graf method, 14% of the stable hips had abnormal USs; by contrast, 19.2% of the subluxatable hips and 17.8% of the dislocatable/dislocated hips had normal Graf morphologies. In USs interpreted using FHC, 16% of stable hips demonstrated abnormal coverage, whereas 13.5% of subluxatable hips and 4.4% of dislocatable/dislocated hips had normal FHC. Incidence of clinically detectable hip instability was 9.8% among newborns in our series. Both alpha angle and FHC ratio revealed substantial interobserver agreement while beta angle achieved moderate agreement. FHC ratio possesses higher sensitivity and similar specificity compared with the Graf method when screening unstable hips. Level II, development of diagnostic criteria on basis of consecutive patients
Background This study investigated the association between early Graf classification and femoral head coverage (FHC) with the acetabular index (AI) at the age of 6 months. Methods A prospective observational study was conducted between 2017–2018. Patients requiring Pavlik harness treatment and patients with syndromic dislocation or neurogenic dislocation were excluded. In total, 169 newborns with the first ultrasound performed at the mean age of 12.3 (0–15) days, the second ultrasound performed at the mean age of 3.2 (2.5–4.1) months, and the AI measured at the age of 6.6 (4.3–7.1) months were enrolled. The correlation between the AI and first and second alpha angles and FHC measurements, and the correlation of dysplasia in early ultrasound with dysplasia in the AI were analyzed. Results At the first ultrasound, only the FHC (P = .02) demonstrated a significant negative correlation with the AI. At the second ultrasound, both the alpha angle (P < .01) and FHC (P < .01) demonstrated a significant negative correlation with the AI. With the AI as a reference, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 77%, 7%, 5%, and 81%, respectively, for the first Graf; 91%, 37%, 9%, and 98%, respectively, for the first FHC measurement; 82%, 90%, 35%, and 99%, respectively, for the second Graf; and 95%, 97%, 68% and 99%, respectively, for the second FHC measurement. Conclusions FHC and alpha angle exhibited significant negative correlations with the AI at six months, both ultrasound parameters may have the potential to predict AI in DDH screening. Compared to the ultrasound measurements taken at 2 weeks, Graf and FHC at 3 months demonstrated superior sensitivity, specificity, PPV, and NPV to detect abnormal AI. The best timing to perform ultrasound examination may need further research.
Background: The timing of post-operative full weight-bearing in patients of isolated displaced lateral malleolar fractures remains controversial. The aim of this study was to evaluate the outcomes of early full weight-bearing after rigid internal fixation of such fractures with locking plates. Methods: From 2012 to 2018, 46 patients who had closed isolated displaced lateral malleolar fractures were included in the study. All fractures were managed with open reduction and internal fixation with locking plates. The patients were allowed to walk bearing their full weight 2 weeks after the operation. The follow-up period was 41.5 months on average (range: 12-70 months). The patients were available to evaluate union conditions, functional results, and complications. Results: The fractures united smoothly with an average union time of 10.5 weeks (range: 8-16). At the final follow-up, the average American Orthopaedic Foot and Ankle Score Ankle-Hindfoot Score was 91 (range: 85-98). No complications were observed. Conclusion: For patients with isolated displaced lateral malleolar fractures, full weight-bearing is safe and effective, without an increase in the rate of complications, 2 weeks after open reduction and rigid fixation with locking plates.
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