Paediatric hip ultrasound: Uncertainties in examination and choice of treatment

Abstract

Purpose In Germany, neonates undergo hip sonography examination using the Graf method during the routine U3 screening examination, performed by consultant physicians four to five weeks after birth, and are referred to specialized orthopaedic departments if there are any uncertainties. This study evaluated the quality of sonographic screening in the outpatient sector and the treatment requirements of referred children. Methods We performed a retrospective analysis of the patient data of 384 neonates collected in consultations performed between April 2016 and April 2019. Results In total, 74% (n = 284) of neonates presented a hip type Ia/b. Treatment (abduction brace or Fettweis cast) was required in 32% (n = 122) of cases. The treatment duration was significantly correlated with age at first presentation (Pearson’s r = 0.678; p = 0.001). The treatment duration for patients aged > 200 days old at first presentation was twice as long as those aged 100 days at first presentation. Patients with public health insurance require referral by a consultant. Developmental dysplasia of the hip as referral diagnosis could not be confirmed in control examination in 64% (n = 132) of cases. Of the public health insured children, 97% (n = 200) were referred through a consultant paediatrician. Conclusion We identified deficits in performing and interpreting the Graf method of ultrasound examination. A total of 64% of referred pathological hips turned out to be physiological configurations in our control examination. The future goal should be to increase anatomical knowledge of the newborn hip and ensure the correct use of Graf ultrasound method. Advanced training courses are recommended and necessary. Level of evidence IV

ECAD Study: Evaluating agreement degree among paediatricians in hip dysplasia assessment by Graf ultrasound method

“…The extensive demonstration of the validity of the method, as well as the good results in other European countries, makes us select this technique as the most appropriate for our study (12). This screening method is performed in most European centres by trained personnel specialized in traumatology and orthopaedics (13). In our environment, we consider that, since examination and follow-up of the newborn and healthy child is carried out by paediatricians, they are the most suitable for performing the technique and it allows to implement universal screening, without overloading other specialties.…”

Fifty percent of patients undergoing periacetabular osteotomy for hip dysplasia showed normal findings upon neonatal ultrasound screening

“…The German Association of Statutory Health Insurance Physicians reported that 32% of consultants who applied for initial certification in infant hip sonography did not undertake adequate training [19]. Bucher et al reported that the initial diagnosis at neonatal sonography screening of 132 neonates was confirmed by a certified pediatrician in only 75 cases [20].…”