Reliability of radiological measurements in the assessment of the child's hip

Broughton, Nigel S.; Brougham, D. I.; Wg, Cole; Menelaus, Malcolm B.

doi:10.1302/0301-620x.71b1.2915007

Cited by 141 publications

(88 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although the decision to treat was made in the setting of both clinical and radiographic evaluation, the percentage of patients with normal ultrasounds who were treated at the 4-6-month mark that had acetabular indices at least two standard deviations greater than age-adjusted normal values [7] was 62% versus 26% of those patients ultimately discharged. Consistent, non-rotated pelvic radiographs can be difficult to obtain in this patient population, and the measurement error of acetabular indices ranges from 2°to 6° [18][19][20]. We, therefore, take both anteroposterior (AP) and frog-leg pelvis X-rays in an attempt to capture the best possible view of the hips, which we find especially helpful in evaluating the quality of the sourcil and measuring the acetabular index.…”

Section: Discussionmentioning

confidence: 99%

Is ultrasound screening for DDH in babies born breech sufficient?

Imrie

Scott

Stearns

et al. 2010

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

Purpose To review our incidence of developmental dysplasia of the hip (DDH) in breech infants referred for ultrasound screening and to determine if subsequent follow-up radiographs are necessary in these patients with normal clinical and ultrasound examinations. Methods A review of the clinical data and imaging studies of all children with the risk factor of breech presentation that were referred for orthopedic evaluation over a 5-year period was conducted. All patients were examined by a fellowship-trained pediatric orthopedic surgeon and all ultrasounds were done at approximately 6 weeks of age by an experienced ultrasonographer. Ultrasounds were evaluated using the dynamic method as described by Harcke. As per our protocol, all patients with normal screening ultrasounds were brought back for a final clinical examination and radiographic check at 4-6 months. Acetabular dysplasia was indicated by radiographic parameters-if there was severe blunting of the sourcil, abnormal acetabular index for age, or if there was significant asymmetry of acetabular indices side-to-side-in the setting of clinical parametersif there was greater than 10°difference in side-to-side abduction or symmetric abduction of less than 60°. Results Three hundred patients with the risk factor of breech presentation were included. Thirty-four patients had clinically unstable hips; 266 had clinically stable hips and were screened by ultrasound. Sixty-four percent were female and 36% were male. Twenty-seven percent of these breech patients had abnormal screening ultrasounds and were subsequently treated. Of the remaining 73% with normal ultrasounds, who were returned per protocol at a mean of 5 months, 29% had evidence of dysplasia and underwent treatment. The diagnosis of dysplasia following a normal ultrasound was based on both radiographic and clinical parameters. Of the hips treated with a Pavlik harness, 62% had acetabular indices at least two standard deviations from the age-corrected average versus 26% of patients not treated. The average length of follow-up was 10 months. Conclusions Retrospectively, we found that, at approximately 6 weeks of age, ultrasound screening of breech patients with clinically stable hips produces an incidence of DDH of 27%. In those patients with a normal ultrasound, 29%, at 4-6 months radiographic follow-up, were found to have dysplasia requiring treatment. This data supports breech as the most important risk factor for hip dysplasia and we, therefore, recommend careful and longitudinal evaluation of these patients with: a careful newborn physical examination, an ultrasound at age 6 weeks, and an anteroposterior (AP) pelvis and frog lateral radiograph at 6 months, as the risk of subsequent dysplasia is too high to discharge patients after a normal ultrasound.Keywords Developmental dysplasia of the hip Á Ultrasound Á Breech presentation Study conducted at Rady Children's Hospital,

show abstract

Section: Discussionmentioning

confidence: 99%

Is ultrasound screening for DDH in babies born breech sufficient?

Imrie

Scott

Stearns

et al. 2010

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

show abstract

“…Several studies have attempted to determine the predictors of outcome or prognosis factors, or evaluation of specific indicators for the need for pelvic osteotomy [5,10,17] . Our study, as other researchers have proposed [18,19], to assess the value of imaging features of DDH after birth up to two to three years using pelvic plain film, in order to develop a simple, reliable indicator to predict radiological DDH and its association with the requirements of salvage osteotomy.…”

Section: Resultsmentioning

confidence: 99%

Retrospective analysis of the radiographic indicators for peri-acetabular osteotomy of developmental dysplasia in children

Zhen

Yin

Tan³

et al. 2015

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose Open surgery, nonsurgical positioning device and casting are mainstay treatments of developmental dysplasia of the hip (DDH). The optimal indicators for surgical interventions remain unclear. In this study, we aim to establish empirical, sensitive radiographic indicators for periacetabular osteotomy intervention in developmental dysplasia in Chinese children. Methods One hundred and three DDH patients treated in The Soochow University Children's Hospital between 2006 and 2012 were assessed; patients with known causes of neuron muscular and abnormal hip joint origin were excluded. Fifty-four suitable patients, demonstrating 71 dysplasia hips with complete clinical record and adequate X-ray films, were enrolled in this study. Patients were divided into group A (conservative interventions failed, followed by salvage periacetabular osteotomy) and group B (conservative treatment only); a total of 16 quantitative parameters were measured on each pelvic X-ray film. Results Among 71 hip joints measured, 29 hips of group A underwent salvage peri-acetabular osteotomy (40.8 %,) showed higher X2, Y, h, and Smith c/b (Vh) (p<0.05). The age, c, HT, b, A2 in the group A salvage operation were statistically significantly different compared to group B patients (without salvage operations) (p<0.05). Conclusions Pre-operative pelvic X-ray film assessment of acetabulum lateralization markers (X2, c, HT, c/b ratio) and the superior migration measurements (Y, h, h/b ratio) are potentially valuable radiographic indicators for determining which DDH patients will require peri-acetabular osteotomy.

show abstract

“…Broughton et al [2] described the acetabular index and the center-edge angle to be the most reliable methods to measure the degree of dysplasia. For the acetabular index, they described a 95% prediction interval of ± 6.1 for intraobserver variability and ± 5.5 for interobserver variability.…”

Section: Methodsmentioning

confidence: 99%

“…For the acetabular index, they described a 95% prediction interval of ± 6.1 for intraobserver variability and ± 5.5 for interobserver variability. For the center-edge angle, they described a 95% prediction interval of ± 9.3 for intraobserver variability and ± 9.1 for the interobserver variability [2].…”

Section: Methodsmentioning

confidence: 99%