Is Radiographic Imaging Necessary for Identifying Late Developmental Dysplasia of the Hip in Breech Infants with Normal Ultrasounds?

Purpose. The goal of our study was to investigate the prevalence of late DDH cases in breech infants who had a normal screening hip ultrasound and subsequent follow-up hip x-ray imaging. Methods. Infants with a history of intrauterine breech position, normal hip ultrasound within 3-months of birth, and follow-up hip x-rays within 2-years were included. Acetabular indices were measured on a supine AP pelvis radiograph. Results. Fifty-six patients had breech presentation at birth, a normal hip ultrasound, and returned for radiographic evaluation within 2 years. Of those, 11/112 (10%) of hips had late DDH based on their radiographic images at 1 standard deviation greater than normative values from age-adjusted controls. No infants showed hip dysplasia at 2 standard deviations greater than normative values from age-adjusted controls. Conclusions. Our results support previous studies that follow up should be considered for infants with breech presentation and normal hip ultrasounds near birth. Level of evidence. II.

[1]  A. R. Morris,et al.  Does Late Hip Dysplasia Occur After Normal Ultrasound Screening in Breech Babies? , 2017, Journal of pediatric orthopedics.

[2]  W. Sankar,et al.  Incidence of acetabular dysplasia in breech infants following initially normal ultrasound: the effect of variable diagnostic criteria , 2017, Journal of children's orthopaedics.

[3]  R. Fitch.  Ultrasound for Screening and Management of Developmental Dysplasia of the Hip , 2014, North Carolina Medical Journal.

[4]  J. Hunter,et al.  Current screening recommendations for developmental dysplasia of the hip may lead to an increase in open reduction. , 2013, The bone & joint journal.

[5]  A. Rehm,et al.  Should all twins and multiple births undergo ultrasound examination for developmental dysplasia of the hip?: A retrospective study of 990 multiple births. , 2013, The bone & joint journal.

[6]  M. Ditchfield,et al.  Developmental dysplasia of the hip: Controversies and current concepts , 2012, Journal of paediatrics and child health.

[7]  Elaine N. Skopelja,et al.  The Epidemiology and Demographics of Hip Dysplasia , 2011, ISRN orthopedics.

[8]  H. Nawaz,et al.  Developmental dysplasia of the hip , 2010, Orthopedic reviews.

[9]  S. Mubarak,et al.  Is ultrasound screening for DDH in babies born breech sufficient? , 2010, Journal of children's orthopaedics.

[10]  C. Bache,et al.  Risk factors for Developmental Dysplasia of the Hip: Ultrasonographic Findings in the Neonatal Period , 2002, Journal of pediatric orthopedics. Part B.

[11]  Clinical Practice Guideline: Early Detection of Developmental Dysplasia of the Hip , 2000, Pediatrics.

[12]  R Graf,et al.  Fundamentals of Sonographic Diagnosis of Infant Hip Dysplasia , 1984, Journal of pediatric orthopedics.

[13]  D. Tönnis.  Normal values of the hip joint for the evaluation of X-rays in children and adults. , 1976, Clinical orthopaedics and related research.