Diagnostic and prognostic values of standard and dynamic ultrasound in early detection and treatment of developmental hip deformity

Abstract

Introduction A clinical examination of a newborn infant is indispensable, but certainly insufficient for a diagnosis of developmental deformity of the hip (DDH) to be made. The use of the ultrasound in the diagnostics of DDH, beside the visualization and making the respective clinical findings objective, made possible verification (still without a distinction of the tissues) of the two basic categories of the primary condition of a newborn baby hips. Objective The purpose of this study was to find out the optimal methodological procedure for the early detection of DDH in newborn infants and suckling. Method During 2002 and 2003, at the Neonatal Department of the Clinic for Gynecology and Obstetrics, Novi Sad, as well as at the Institute for Orthopedic Surgery "Banjica" Belgrade, there were 4016 newborn infants examined, i.e. 8032 hips clinically and by ultrasound. The standard Graf?s methodological procedure was applied completely, supplemented by the dynamic examination by pushing back and stretching femora along, that is by the techniques of Couture and Harcke. Results In order to categorize the condition of the hip of a newborn infant, the sonographic classification of R. Graaf, Th. Harcke and D. Pajic was used. The ultrasound analysis demonstrated a frequency of the sonotype Ia in 552 (13.08%) of the newborn infants, the sonotype Ib in 2934 (73.00%), the sonotype IIa+ in 481 (11.97%) and the pathological cases with sonotypes IIg 42 (1.04%), IId 17 (0.42%), IIIa 15 (0.37%) and IV 5 (0.12%). The total number of unstable critical, discentering and discentered cases of DDH was 79 (1.95%). The incidence of DDH was three times more frequent in girls, mostly bilateral; when unilateral, it was more frequent in the left one. The results of the early treatment were uniformly excellent, but in two cases there was established osteochondritis of the first degree (Pavlik?s harness 1, Von Rosen?s splint 1). Conclusion It has been proven that the clinical examination was inevitable, but insufficient for diagnosis of DDH. The standard sonographic examination should be supplemented by provocative dynamic diagnostic procedures in all immature, at risk and discentering hips. By doing so, it is possible to differentiate prognostically the hips evolving to a spontaneous normalization from those striving to a progredient decentralization. For a sonographic diagnosis, the first three weeks are essential, but for therapy, the crucial is the sixth week.