The diagnosis of congenital hip-joint dislocation by the ultrasonic combound treatment

Graf, Reinhard

doi:10.1007/bf00450934

Cited by 419 publications

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“…21 The ultrasound method is based on Graf' s coronal standard section through the midacetabulum, and each hip is classified according to morphology and stability, separately. 43 The ultrasound examination was thoroughly standardized before the RCT. 44 All high-risk infants with normal hips at birth had a hip-radiograph at age 4.…”

Section: Discussionmentioning

confidence: 99%

Screening Strategies for Hip Dysplasia: Long-term Outcome of a Randomized Controlled Trial

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Only 2 randomized controlled trials have addressed effects of ultrasound screening for developmental hip dysplasia. Both concluded that adding universal or selective ultrasound to routine clinical examination gave a nonsignificant reduction in rates of late presenting cases, but higher treatment rates. WHAT THIS STUDY ADDS:This maturity review assesses long-term outcome of one of these trials. Rates of radiographic findings indicating acetabular dysplasia and degenerative change were similar across the 3 screening groups in young adulthood. Increased treatment rates were not associated with avascular necrosis. abstract OBJECTIVE: Screening for hip dysplasia is controversial. A previous randomized controlled trial revealed that adding universal or selective ultrasound to routine clinical examination gave a nonsignificant reduction in rates of late presenting cases, but with higher treatment rates. This study assesses differences in outcome at skeletal maturity for the 3 newborn screening strategies in terms of radiographic markers of acetabular dysplasia and early degenerative change and avascular necrosis (AVN) secondary to neonatal treatment. METHODS:From the initial trial including 11 925 newborns, a populationbased sample of 3935 adolescents was invited for follow-up at age 18 to 20 years. A standardized weight-bearing anteroposterior view was obtained. The outcomes evaluated were the radiographic findings of dysplasia (center-edge angle, femoral head extrusion-index, acetabular depth-width ratio, Sharp' s angle, subjective evaluation of dysplasia) and degenerative change (joint-space width). Signs of AVN were documented. RESULTS:Of the 3935 subjects invited, 2038 (51.8%) attended the maturity review, of which 2011 (58.2% female patients) were included: 551, 665, and 795 subjects from the universal, selective, and clinical groups, respectively. Rates per group of positive radiographic findings associated with dysplasia or degenerative change varied depending on radiographic marker used. No statistically significant differences were detected between groups. No AVN was seen. CONCLUSIONS:Although both selective and universal ultrasound screenings gave a nonsignificant reduction in rates of late cases when compared with expert clinical programs, we were unable to demonstrate any additional reduction in the rates of radiographic findings associated with acetabular dysplasia or degenerative change at maturity. Increased treatment rates were not associated with AVN. Pediatrics 2013;132:492-501

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Section: Discussionmentioning

confidence: 99%

Screening Strategies for Hip Dysplasia: Long-term Outcome of a Randomized Controlled Trial

et al. 2013

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“…Ideally, therefore, the condition should be diagnosed within the first six weeks of life. In recent years, the increasing use of ultrasound [5] has markedly changed the diagnostic approach to this disorder. Today, in fact, ultrasonography represents the method of choice for screening newborns for dysplasia of the hip during the first months of life [6].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound in developmental dysplasia of the hip: A screening study in Sardinian newborns

Dessì

Crisafulli

Vannelli

et al. 2009

Journal of Ultrasound

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KEYWORDSDysplasia of the hip; Ultrasound; Newborn; Screening; DDH.Abstract Introduction: Developmental dysplasia of the hip (DDH) is the most frequent inborn deformity of the locomotor apparatus. Ultrasound screening is frequently used to identify DDH in view of the brevity of the preclinical period during which diagnosis is possible. Appropriate therapeutic intervention during this period can positively affects the evolution of the disorder. Methods: An unselected population of 1158 Sardinian neonates underwent ultrasound examinations of both hips, and findings were classified according to the method described by Graf. Patients were assessed by means of retrospective analysis to reveal cases of congenital dislocation of the hip joint. All cases were classified and treatment outcomes determined. Results: A total of 145 hips requiring treatment were observed in 122 children. Hip dysplasia and/or dislocation were diagnosed between the ages of 14 days and 3 months. One month after diagnosis ultrasound findings were normal in 94% of the infants with at least one hip classified as type 2a. The remaining 6% were classified as types 2b, 2c, D, and 3. All were treated with abduction splints, and normal hip development was observed after one or two months of treatment. Type 4 hips were referred to an orthopedic surgeon for specialist treatment. Conclusions: When performed by skilled operators, ultrasonographic techniques are of considerable value in prescribing treatment for DDH. The satisfactory prognosis associated with early treatment of severe congenital dislocation of the hip joint underlines the advisability of scheduling routine hip screening programs to ensure early diagnosis and effective treatment of the disorder.Sommario Introduzione: La displasia evolutiva dell'anca (DDH) costituisce la deformità più frequente dell'apparato locomotore. Lo screening ecografico è la metodica più utilizzata nell'identificazione della DDH, considerando la brevità del periodo in cui la diagnosi è possibile prima della comparsa dei sintomi clinici. Un intervento terapeutico appropriato precoce può avere un effetto positivo in relazione all'evoluzione di tale patologia. Metodi: L'esame ecografico, la sua valutazione, la classificazione e la tipizzazione delle anche sono stati effettuati secondo il metodo descritto dal Graf. I pazienti sono stati valutati per mezzo di un'analisi retrospettiva volta a identificare i casi di DDH. Tutti i casi sono stati classificati e in base a ciò si è deciso il tipo di trattamento da attuare. Risultati: Complessivamente sono state osservate 145 anche in 122 bambini che presentavano un certo grado di displasia. L'età alla diagnosi variava da 14 a 90 giorni con una media di 52 giorni di vita. Un mese dopo la diagnosi ecografica le anche di tipo 2a, sia bilaterali che unilaterali, sono risultate normali nel 94%. Il restante 6% così come i tipi 2b, 2c, D e 3 sono stati trattati con un divaricatore e la guarigione completa è stata ottenuta dopo due mesi di trattamento. Il tipo 4 è stato monitorato esclusi...

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“…Ultrasound of the hips for developmental dysplasia of the hip (DDH) was introduced at least 25 years ago [11] and has had a tremendous impact on the early detection of DDH [14]. Although there are continuing controversies regarding what type of scan to perform, when to perform the scan, and which infants should have a scan, DDH is being diagnosed at an earlier age, leading to more successful and less invasive treatment [12,15].…”

Section: Introductionmentioning

confidence: 99%

Imaging in the Surgical Management of Developmental Dislocation of the Hip

Grissom

Harcke

Thacker

2008

Clinical Orthopaedics &Amp; Related Research

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Although the use of ultrasound in the diagnosis and early treatment of developmental dysplasia of the hip (DDH) has reduced the number of patients diagnosed late and decreased the number of operative procedures, surgical treatment is still needed in some patients. Late cases continue to occur as a result of missing the screening examination, being normal at initial screening and missing followup. Dysplasia may persist despite appropriate nonoperative or operative treatment. Many of these patients subsequently undergo closed or open reduction and femoral or acetabular reconstruction. Ultrasound of the hips is generally used up to 6 or 8 months of age, during which time the hips are largely cartilaginous, and radiographs after that time when bony development is more complete. Options to supplement ultrasound and radiography include arthrography, computed tomography, and magnetic resonance imaging. Several advances have been made in the imaging of DDH and its complications including acetabular labral pathology and of femoroacetabular impingement (FAI). We review imaging techniques other than ultrasound used in the management of DDH.

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The diagnosis of congenital hip-joint dislocation by the ultrasonic combound treatment

Cited by 419 publications

References 0 publications

Screening Strategies for Hip Dysplasia: Long-term Outcome of a Randomized Controlled Trial

Screening Strategies for Hip Dysplasia: Long-term Outcome of a Randomized Controlled Trial

Ultrasound in developmental dysplasia of the hip: A screening study in Sardinian newborns

Imaging in the Surgical Management of Developmental Dislocation of the Hip

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