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J Child Orthop. 2017 Oct 1;11(5):358-366. doi: 10.1302/1863-2548.11.170031.

Obstacles to reduction in infantile developmental dysplasia of the hip.

Author information

1
Paediatric Orthopaedic Department, Women's and Children's Hospital, 72 King William Road, North Adelaide, Adelaide, SA 5006, Australia and Paediatric Orthopaedic Department, Children's Hospital of Eastern Switzerland,, Claudiusstrasse 6, 9006 St Gallen, Switzerland.
2
Paediatric Orthopaedic Department, Women's and Children's Hospital, 72 King William Road, North Adelaide, Adelaide, SA 5006, Australia and University of Adelaide, Centre for Orthopaedic and Trauma Research, Adelaide, SA, Australia.
3
Department of Orthopaedics and Trauma, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.
4
Young Adult Limb Preservation and Reconstruction, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
5
Division of Medical Imaging, Women's and Children's Hospital, 72 King William Road, North Adelaide, Adelaide, SA 5006, Australia.

Abstract

PURPOSE:

Identification of anatomical structures that block -reduction in developmental dysplasia of the hip (DDH) is -important for the management of this challenging condition. Obstacles to reduction seen on arthrogram are well-known. However, despite the increasing use of MRI in the assessment of adequacy of reduction in DDH, the interpretation of MRI patho-anatomy is ill-defined with a lack of relevant literature to guide clinicians.

METHOD:

This is a retrospective analysis of the MRI of patients with DDH treated by closed reduction over a five-year period (between 2009 and 2014). Neuromuscular and genetic disorders were excluded. Each MRI was analysed by two orthopaedic surgeons and a paediatric musculoskeletal radiologist to identify the ligamentum teres, pulvinar, transverse acetabular ligament (TAL), capsule, labrum and acetabular roof cartilage hypertrophy. Inter- and intraobserver reliability was calculated. The minimum follow-up was 12 months.

RESULTS:

A total of 29 patients (38 hips) underwent closed reduction for treatment of DDH. Eight hips showed persistent subluxation on post-operative MRI. Only three of these eight hips showed an abnormality on arthrogram. The pulvinar was frequently interpreted as 'abnormal' on MRI. The main obstacles identified on MRI were the ligamentum teres (15.8%), labrum (13.1%) and acetabular roof cartilage hypertrophy (13.2%). The inter-rater reliability was good for TAL, capsule and pulvinar; moderate for ligamentum teres and labrum; and poor for hypertrophied cartilage.

CONCLUSION:

The labrum, ligamentum teres and acetabular roof cartilage hypertrophy are the most important structures seen on MRI preventing complete reduction of DDH. Focused interpretation of these structures may assist in the management of DDH.

KEYWORDS:

MRI; arthrogram; closed reduction; infantile dysplasia of the hip; obstacles to reduction

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