Difficulties in diagnosing and managing congenital dislocation of the hip.

Noble, Timothy; Pullan, C R; Craft, A W; Leonard, Michael

doi:10.1136/bmj.2.6137.620

Cited by 19 publications

(8 citation statements)

References 7 publications

(3 reference statements)

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“…Evidence was found in 24 studies (target articles 1,4,7,9,12,14,15,23,25,27,30,38,40,44,[72][73][74][75][76][77][78][79][80][81]. The study by Dunn and O'Riordan (target article 14) provided 2 arms.…”

Section: A After Pediatric Screeningmentioning

confidence: 99%

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Developmental Dysplasia of the Hip Practice Guideline: Technical Report

et al. 2000

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After discussion, explicit modeling, and critique, an influence diagram of 31 nodes was created. The computer-based and the hand literature searches found 534 articles, 101 of which were reviewed by 2 or more readers. Ancestor searches of these yielded a further 17 articles for evidence abstraction. Articles came from around the globe, although primarily Europe, British Isles, Scandinavia, and their descendants. There were 5 controlled trials, each with a sample size less than 40. The remainder were case series. Evidence was available for 17 of the desired 30 probabilities. Evidence quality ranged primarily between one third and two thirds of the maximum attainable score (median: 10-21; interquartile range: 8-14). Based on the raw evidence and Bayesian hierarchical meta-analyses, our estimate for the incidence of DDH revealed by physical examination performed by pediatricians is 8.6 per 1000; for orthopaedic screening, 11.5; for ultrasonography, 25. The odds ratio for DDH, given breech delivery, is 5.5; for female sex, 4.1; for positive family history, 1.7, although this last factor is not statistically significant. Postneonatal cases of DDH were divided into mid-term (younger than 6 months of age) and late-term (older than 6 months of age). Our estimates for the mid-term rate for screening by pediatricians is 0.34/1000 children screened; for orthopaedists, 0.1; and for ultrasonography, 0.28. Our estimates for late-term DDH rates are 0.21/1000 newborns screened by pediatricians; 0.08, by orthopaedists; and 0.2 for ultrasonography. The rates of AVN for children referred before 6 months of age is estimated at 2.5/1000 infants referred. For those referred after 6 months of age, our estimate is 109/1000 referred infants. The decision model (reduced, based on available evidence) suggests that orthopaedic screening is optimal, but because orthopaedists in the published studies and in practice would differ, the supply of orthopaedists is relatively limited, and the difference between orthopaedists and pediatricians is statistically insignificant, we conclude that pediatric screening is to be recommended. The place of ultrasonography in the screening process remains to be defined because there are too few data about postneonatal diagnosis by ultrasonographic screening to permit definitive recommendations. These data could be used by others to refine the conclusions based on costs, parental preferences, or physician style. Areas for research are well defined by our model-based approach.

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Section: A After Pediatric Screeningmentioning

confidence: 99%

“…There were 17 studies providing evidence (target articles 2, 13,35,37,42,43,51,54,58,60,77,[82][83][84][85][86][87]. Infants were referred to orthopaedists during the newborn period in each study except 2.…”

Section: A After Early Referralmentioning

confidence: 99%

Developmental Dysplasia of the Hip Practice Guideline: Technical Report

et al. 2000

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“…Swaddling also increases the risk (8). When the femoral head is out of its place, the normal growth stops and infants have relative ligamentous laxity at birth (9,10). Early manifestations of the disorder are rare and it is mostly diagnosed with the Ortolani and the Barlow maneuvers based on the Ortolani and the Barlow clinical symptoms (11,12).…”

Section: Introductionmentioning

confidence: 99%

“…Gradually, permanent symptoms and complications of the disease such as inconsistency of folds in gluteal area, reduced abduction, limping, osteoarthritis, and short limbs appear; hence, the delay in diagnosis is associated with severe and irreparable complications (9,10). Ultrasound is the gold standard diagnosis method (14,15).…”

Section: Introductionmentioning

confidence: 99%

“…Radiography and ultrasonography are also used to confirm the diagnosis in suspected cases (16)(17)(18). Since clinical symptoms are not always detectable, some cases could not be diagnosed at early stages, which leads to serious and irreversible complications (9,10). Several studies are conducted to compare the diagnostic value of ultrasound to evaluate the clinical examination to diagnose congenital hip dislocation in preterm infants.…”

Section: Introductionmentioning

confidence: 99%

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Millennium Development Goal Four; Child and Infant Mortality, Achievements in Economic Cooperation Organization Countries: An Ecological Study

et al. 2013

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Background: Developmental dislocation of the hip joint is among joint abnormalities and lack of its early diagnosis leads to irreversible complications and disabilities. Methods: The current cross sectional study was conducted on 210 eighteen -month -old premature infants. Premature infants at term gestational age were examined by a neonatologist and underwent a sonographic scanning by a skilled radiologist. The results of the physical examination and ultrasound reports were collected and analyzed. Results: In the clinical assessment, hip joint examination was diagnosed abnormal in 22 cases (10.4%) and joint dislocation was diagnosed by ultrasonographic examination in 17 patients (8.1%). In one high -risk case, despite normal clinical examination (0.48%), the dislocation was diagnosed by ultrasonographic evaluation. There was a significant relationship between hip dislocation rate, and reduced mean gestational age and birth weight (P < 0.05). The dislocation prevalence in the twins was significantly more than that of other infants (P = 0.001). In the current study, there was no statistically significant relationship between gender, family history, oligohydramnios, presentation, and type of delivery with joint dislocation (P > 0.05). In diagnosis of joint dislocation, clinical examination (the results of the Ortolani and the Barlow tests) had sensitivity of 94% and specificity of 97% compared with sonography; the positive and negative predictive values were 73% and 99%, respectively. Conclusions: Clinical examination has high sensitivity and specificity for early diagnosis of developmental hip dislocation. If there are risk factors, ultrasonographic scanning is recommended despite normal physical examination, and ultrasound is not necessary in case of normal physical examination and the absence of risk factors.

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Genetic and Environmental Aetiological Factors and Family Studies in the Prevalence of CDH

Wilkinson¹

1985

Congenital Displacement of the Hip Joint

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Difficulties in diagnosing and managing congenital dislocation of the hip.

Cited by 19 publications

References 7 publications

Developmental Dysplasia of the Hip Practice Guideline: Technical Report

Developmental Dysplasia of the Hip Practice Guideline: Technical Report

Millennium Development Goal Four; Child and Infant Mortality, Achievements in Economic Cooperation Organization Countries: An Ecological Study

Genetic and Environmental Aetiological Factors and Family Studies in the Prevalence of CDH

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