Incidence and Treatment of Developmental Hip Dysplasia in Mongolia: A Prospective Cohort Study

Abstract

BackgroundIn 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 FindingsDuring 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/SignificanceThis 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.

Accuracy of Trained Physicians is Inferior to Deep Learning-Based Algorithm for Determining Angles in Ultrasound of the Newborn Hip

“…Results Three methods were implemented, each with a different abstraction of the problem: (1) CNNs that directly learn the angles without any post-processing steps; (2) CNNs that return the relevant landmarks in the image to identify the angles; (3) CNNs that return the base line, bony roof line, and the cartilage roof line which are necessary to calculate the angles. The RMSE between physicians and ground truth were found to be 7.1°for alpha.…”

“…The RMSE between physicians and ground truth were found to be 7.1°for alpha. The best CNN architecture was (2) landmark detection. The RMSE between landmark detection and ground truth was 3.9°for alpha.…”

Incidence of Newborn Developmental Dysplasia of Hip in İstanbul Sultangazi Regional

“…Dünyadaki insidansı tam bilinmemekle birlikte binde 1 ila 34 arasında olduğu tahmin edilmektedir (7,15). Moğolistan'da yapılan bir çalışmada GKD insidansı %0,7 olarak bildirilmiştir (16). Avrupa'da yenidoğanlarda fizyolojik immatür kalça görülme insidansı %3 ila 13 arasındayken, gerçek displazi oranlarının %1 ila 3 düzeyinde görüldüğü bildirilmiştir (17)(18)(19).…”

“…Avrupa'da yenidoğanlarda fizyolojik immatür kalça görülme insidansı %3 ila 13 arasındayken, gerçek displazi oranlarının %1 ila 3 düzeyinde görüldüğü bildirilmiştir (17)(18)(19). Raporlanan farklı insidansların temelinde GKD'ye olan genetik yatkınlık, tarama tekniklerindeki farklılık, iklim ve coğrafi nedenlere bağlı değişkenler ve bebek büyütme alışkanlıklarındaki kültürler arası farklılıklar vardır (16,(20)(21)(22). Türkiye'den farklı zamanlarda ve farklı bölgelerde yapılan çalışmalar arasındaki farklar (%0,047-17) göz önüne alındığında bu konu daha net anlaşılabilmektedir (3,(12)(13)(14)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36).…”

Update Hüftreifungsstörung – Diagnostik und Behandlung

“…Auch wenn sich daraus keine Empfehlung ableiten lässt, darf erwähnt werden, dass im Rahmen unseres Projektes in bislang 3 Einzelfällen selbst Hüftgelenke des Typs IV bzw. der Gruppe D durch alleinige Anwendung einer Tübinger Schiene geheilt wurden.In einer mongolischen Neugeborenenkohorte fanden wir per Ultraschall mit der Methode von Graf eine Inzidenz von 0,7 % (124 von 16 712 Hüften), respektive 1,3 % (107 von 8356 Kindern) für Hüftdysplasie[17]. Alle dysplastischen Hüften konnten mit einer einfachen, nicht belastenden und sicheren Abspreiztherapiewelche durch die Eltern erfolgteinnerhalb von wenigen Wochen Die Diagnostik und die Behandlung mittels Tübinger Schienen werden von Pädiatern und Neonatologen durchgeführt und überwacht.…”