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Pediatr Radiol. 2014 Apr;44(4):410-24. doi: 10.1007/s00247-013-2838-3. Epub 2013 Dec 13.

Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1991-2006.

Author information

1
Department of Clinical Medicine, University of Bergen, Bergen, Norway, lene.bjerke.laborie@helse-bergen.no.

Abstract

BACKGROUND:

Early treatment is considered essential for developmental dysplasia of the hip (DDH), but the choice of screening strategy is debated.

OBJECTIVE:

We evaluated the effect of a selective ultrasound (US) screening programme.

MATERIALS AND METHODS:

All infants born in a defined region during 1991-2006 with increased risk of developmental dysplasia of the hip, i.e. clinical hip instability, breech presentation, congenital foot deformities or a family history of DDH, underwent US screening at age 1-3 days. Severe sonographic dysplasia and dislocatable/dislocated hips were treated with abduction splints. Mild dysplasia and pathological instability, i.e. not dislocatable/dislocated hips were followed clinically and sonographically until spontaneous resolution, or until treatment became necessary. The minimum observation period was 5.5 years.

RESULTS:

Of 81,564 newborns, 11,539 (14.1%) were identified as at-risk, of whom 11,190 (58% girls) were included for further analyses. Of the 81,564 infants, 2,433 (3.0%) received early treatment; 1,882 (2.3%) from birth and 551 (0.7%) after 6 weeks or more of clinical and sonographic surveillance. An additional 2,700 (3.3%) normalised spontaneously after watchful waiting from birth. Twenty-six infants (0.32 per 1,000, 92% girls, two from the risk group) presented with late subluxated/dislocated hips (after 1 month of age). An additional 126 (1.5 per 1,000, 83% girls, one from the risk group) were treated after isolated late residual dysplasia. Thirty-one children (0.38 per 1,000) had surgical treatment before age 5 years. Avascular necrosis was diagnosed in seven of all children treated (0.27%), four after early and three after late treatment.

CONCLUSION:

The first 16 years of a standardised selective US screening programme for developmental dysplasia of the hip resulted in acceptable rates of early treatment and US follow-ups and low rates of late subluxated/dislocated hips compared to similar studies.

PMID:
24337789
DOI:
10.1007/s00247-013-2838-3
[Indexed for MEDLINE]

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