Ultrasound imaging and secondary screening for congenital dislocation of the hip

Abstract

We report the preliminary results of a continuing prospective evaluation of a screening programme for congenital dislocation of the hip (CDH) which uses ultrasound imaging to provide delayed selective screening to complement neonatal clinical screening. Of 26,952 births in the Southampton district, 1894 infants were referred for secondary screening because of a clinical abnormality or the presence of a predetermined risk category for CDH. Pavlik harness treatment was required for only 118 infants, giving a treatment rate of 4.4 per 1000 births. Of those referred with clinical instability, 35% did not require treatment. Dislocation or subluxation was detected in 17 of 643 infants referred only because they fell within one of three risk categories: breech presentation, foot deformity and family history. All 17 had normal clinical examinations and cases were discovered in each category. Six children presented with CDH after 12 weeks of age, giving a late presentation rate of 0.22 per 1000 births. All had normal clinical examinations within 24 hours of birth and none was in a risk category. Surgery has been required in ten children, giving a surgical treatment rate of 0.37 per 1000 births. We conclude that, in Southampton, delayed selective secondary screening with ultrasound is more effective than clinical screening alone. It targets treatment to those infants who need it, and reveals a number of dislocated and subluxed hips that would otherwise be missed.

Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force

“…Although limited, available evidence supports the notion that a high proportion of families follow through with the initial referral. 29 However, we could not determine how many families adhere to ongoing follow-up.…”

“…Primary care-based and population-based cohort studies [26][27][28][29][30][31][32][33][34][35][36] that include Ն1 of the major risk factors are summarized in Table 1. Consistently, only a minority (10 -27%) of all infants diagnosed with DDH in population-based studies have identified risk factors (with the exception of female gender), 30,32,33,35 and among those with risk factors, between 1% and 10% have DDH.…”

“…One study assessed failure to follow-up with a specialty appointment after identification of newborns with an abnormality on examination or the presence of a risk factor for DDH. 29 This specialty clinic, a part of Britain's national health system, followed a systematic approach to contacting nonattenders, including up to 2 letters to the family that explained the reason for referral and safety of ultrasound and offered an appointment the following week, followed by contact with the general practitioner to persuade the family. With this approach, nearly 95% of patients followed up.…”

The efficacy of the Pavlik harness, the Craig splint and the von Rosen splint in the management of neonatal dysplasia of the hip

“…Other studies have shown that many dysplastic hips improve without treatment particularly if they are stable. 1,2,8,18 It is important when comparing studies to ensure that similar groups of patients are included. This is particularly difficult when different ultrasound classifications are used, for example the Graf classification 5 or a classification based on the degree of cover of the femoral head.…”

“…It can detect some dysplastic hips which are missed on clinical examination [1][2][3] and exclude significant dysplasia in some hips which are thought to be abnormal clinically. 4 There is, however, relatively little information in the published literature on the use of ultrasound to assess the outcome and compare splinted hips with those without splintage and the effectiveness of different splints.…”