The Association of Asymmetric Skinfolds and the Diagnosis of Developmental Dysplasia of the Hip in Infants

Background: The clinical finding of asymmetric skinfolds (ASF) in infants is used to indicate the possibility of developmental dysplasia of the hip (DDH). The association of ASF and a diagnosis of DDH remains unknown. Purpose: To determine the association of ASF in the gluteal and femoral regions with a diagnosis of DDH. Methods: The correlation of ASF and other physical examination findings with DDH was compared retrospectively. The medical records of infants who underwent DDH screening in the clinic were analyzed. The physical examination findings were reviewed and categorized as ASF, clunk of the hip, limb-length discrepancy, hip abduction limitation, combined conditions of musculoskeletal disorders, and regular screening for DDH. The hip conditions were classified by Graf's ultrasound method. Type IIb and higher classifications were defined as DDH. The diagnosed rate and severity of DDH based on physical examination findings were calculated and compared. Results: Clinical data of 3266 infants aged up to 6 months were reviewed, and 194 infants were diagnosed with DDH by ultrasound examination. ASF was the most common indication for DDH screening (64.5%; 2107/3266). However, this was poorly correlated with a diagnosis of DDH (4.79%; P < .0001). No difference was found between the Graf classification severity and various indications (P = .079). Implications for Practice: Clinicians should recognize that, although ASF is the most common reason for DDH screening in infants, ASF does not correlate with a diagnosis of DDH. Implications for Research: Additional research should examine the relationship between DDH and ASF in other populations.