Journal of Children's Orthopaedics

, Volume 4, Issue 1, pp 3–8

Is ultrasound screening for DDH in babies born breech sufficient?

  • Meghan Imrie
  • Vanessa Scott
  • Philip Stearns
  • Tracey Bastrom
  • Scott J. Mubarak
Original Clinical Article

Abstract

Purpose

To review our incidence of developmental dysplasia of the hip (DDH) in breech infants referred for ultrasound screening and to determine if subsequent follow-up radiographs are necessary in these patients with normal clinical and ultrasound examinations.

Methods

A review of the clinical data and imaging studies of all children with the risk factor of breech presentation that were referred for orthopedic evaluation over a 5-year period was conducted. All patients were examined by a fellowship-trained pediatric orthopedic surgeon and all ultrasounds were done at approximately 6 weeks of age by an experienced ultrasonographer. Ultrasounds were evaluated using the dynamic method as described by Harcke. As per our protocol, all patients with normal screening ultrasounds were brought back for a final clinical examination and radiographic check at 4–6 months. Acetabular dysplasia was indicated by radiographic parameters—if there was severe blunting of the sourcil, abnormal acetabular index for age, or if there was significant asymmetry of acetabular indices side-to-side—in the setting of clinical parameters—if there was greater than 10° difference in side-to-side abduction or symmetric abduction of less than 60°.

Results

Three hundred patients with the risk factor of breech presentation were included. Thirty-four patients had clinically unstable hips; 266 had clinically stable hips and were screened by ultrasound. Sixty-four percent were female and 36% were male. Twenty-seven percent of these breech patients had abnormal screening ultrasounds and were subsequently treated. Of the remaining 73% with normal ultrasounds, who were returned per protocol at a mean of 5 months, 29% had evidence of dysplasia and underwent treatment. The diagnosis of dysplasia following a normal ultrasound was based on both radiographic and clinical parameters. Of the hips treated with a Pavlik harness, 62% had acetabular indices at least two standard deviations from the age-corrected average versus 26% of patients not treated. The average length of follow-up was 10 months.

Conclusions

Retrospectively, we found that, at approximately 6 weeks of age, ultrasound screening of breech patients with clinically stable hips produces an incidence of DDH of 27%. In those patients with a normal ultrasound, 29%, at 4–6 months radiographic follow-up, were found to have dysplasia requiring treatment. This data supports breech as the most important risk factor for hip dysplasia and we, therefore, recommend careful and longitudinal evaluation of these patients with: a careful newborn physical examination, an ultrasound at age 6 weeks, and an anteroposterior (AP) pelvis and frog lateral radiograph at 6 months, as the risk of subsequent dysplasia is too high to discharge patients after a normal ultrasound.

Keywords

Developmental dysplasia of the hip Ultrasound Breech presentation 

References

  1. 1.
    Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip. American Academy of Pediatrics (2000) Clinical practice guideline: early detection of developmental dysplasia of the hip. Pediatrics 105:896–905CrossRefGoogle Scholar
  2. 2.
    Arumilli BR, Koneru P, Garg NK, Davies R, Saville S, Sampath J, Bruce C (2006) Is secondary radiological follow-up of infants with a family history of developmental dysplasia of the hip necessary? J Bone Joint Surg Br 88:1224–1227CrossRefGoogle Scholar
  3. 3.
    Jellicoe P, Aitken A, Wright K (2007) Ultrasound screening in developmental hip dysplasia: do all scanned hips need to be followed up? J Pediatr Orthop B 16:192–195CrossRefGoogle Scholar
  4. 4.
    Osarumwense D, Popple D, Kershaw IF, Kershaw CJ, Furlong AJ (2007) What follow-up is required for children with a family history of developmental dysplasia of the hip? J Pediatr Orthop B 16:399–402CrossRefGoogle Scholar
  5. 5.
    Harcke HT, Clarke NM, Lee MS, Borns PF, MacEwen GD (1984) Examination of the infant hip with real-time ultrasonography. J Ultrasound Med 3:131–137Google Scholar
  6. 6.
    Clarke NM, Harcke HT, McHugh P, Lee MS, Borns PF, MacEwen GD (1985) Real-time ultrasound in the diagnosis of congenital dislocation and dysplasia of the hip. J Bone Joint Surg Br 67:406–412Google Scholar
  7. 7.
    Scoles PV, Boyd A, Jones PK (1987) Roentgenographic parameters of the normal infant hip. J Pediatr Orthop 7:656–663CrossRefGoogle Scholar
  8. 8.
    Tönnis D (1976) Normal values of the hip joint for the evaluation of X-rays in children and adults. Clin Orthop Relat Res 119:39–47Google Scholar
  9. 9.
    Suzuki S, Yamamuro T (1986) Correlation of fetal posture and congenital dislocation of the hip. Acta Orthop Scand 57:81–84CrossRefGoogle Scholar
  10. 10.
    Holen KJ, Tegnander A, Terjesen T, Johansen OJ, Eik-Nes SH (1996) Ultrasonographic evaluation of breech presentation as a risk factor for hip dysplasia. Acta Paediatr 85:225–229CrossRefGoogle Scholar
  11. 11.
    Bache CE, Clegg J, Herron M (2002) Risk factors for developmental dysplasia of the hip: ultrasonographic findings in the neonatal period. J Pediatr Orthop B 11:212–218Google Scholar
  12. 12.
    Dunn PM (1976) Perinatal observations on the etiology of congenital dislocation of the hip. Clin Orthop Relat Res 119:11–22Google Scholar
  13. 13.
    Bower C, Stanley FJ, Kricker A (1987) Congenital dislocation of the hip in Western Australia. A comparison of neonatally and postneonatally diagnosed cases. Clin Orthop Relat Res 224:37–44Google Scholar
  14. 14.
    Rafique A, Set P, Berman L (2007) Late presentation of developmental dysplasia of the hip following normal ultrasound examination. Clin Radiol 62:181–184CrossRefGoogle Scholar
  15. 15.
    Gwynne Jones DP, Dunbar JD, Theis JC (2006) Late presenting dislocation of sonographically stable hips. J Pediatr Orthop B 15:257–261CrossRefGoogle Scholar
  16. 16.
    Omeroğlu H, Biçimoğlu A, Koparal S, Seber S (2001) Assessment of variations in the measurement of hip ultrasonography by the Graf method in developmental dysplasia of the hip. J Pediatr Orthop B 10:89–95CrossRefGoogle Scholar
  17. 17.
    Portinaro NM, Murray DW, Bhullar TP, Benson MK (1995) Errors in measurement of acetabular index. J Pediatr Orthop 15:780–784CrossRefGoogle Scholar
  18. 18.
    Engesaeter LB, Wilson DJ, Nag D, Benson MK (1990) Ultrasound and congenital dislocation of the hip. The importance of dynamic assessment. J Bone Joint Surg Br 72:197–201Google Scholar
  19. 19.
    Boniforti FG, Fujii G, Angliss RD, Benson MK (1997) The reliability of measurements of pelvic radiographs in infants. J Bone Joint Surg Br 79:570–575CrossRefGoogle Scholar
  20. 20.
    Broughton NS, Brougham DI, Cole WG, Menelaus MB (1989) Reliability of radiological measurements in the assessment of the child’s hip. J Bone Joint Surg Br 71:6–8Google Scholar
  21. 21.
    Herring JA (2008) Developmental dysplasia of the hip. In: Herring JA (ed) Tachdjian’s pediatric orthopaedics, 4th edn. Saunders Elsevier, Philadelphia, p 649Google Scholar
  22. 22.
    Weinstein SL, Mubarak SJ, Wenger DR (2004) Developmental hip dysplasia and dislocation: part II. Instr Course Lect 53:531–542Google Scholar
  23. 23.
    Harris WH (1986) Etiology of osteoarthritis of the hip. Clin Orthop Relat Res 213:20–33Google Scholar
  24. 24.
    Solomon L (1976) Patterns of osteoarthritis of the hip. J Bone Joint Surg Br 58:176–183Google Scholar
  25. 25.
    Stulberg SD, Harris WH (1974) Acetabular dysplasia and development of osteoarthritis of the hip. In: Harris WH (ed) The hip: Proceedings of the Second Open Scientific Session of the Hip Society. CV Mosby, St. Louis, MO, pp 82–93Google Scholar
  26. 26.
    Cooperman DR, Wallensten R, Stulberg SD (1983) Acetabular dysplasia in the adult. Clin Orthop Relat Res 175:79–85Google Scholar
  27. 27.
    Ganz R, Leunig M, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 466:264–272CrossRefGoogle Scholar
  28. 28.
    Carter CO, Wilkinson JA (1964) Genetic and environmental factors in the etiology of congenital dislocation of the hip. Clin Orthop Relat Res 33:119–128Google Scholar

Copyright information

© EPOS 2009

Authors and Affiliations

  • Meghan Imrie
    • 1
  • Vanessa Scott
    • 2
  • Philip Stearns
    • 2
  • Tracey Bastrom
    • 2
  • Scott J. Mubarak
    • 2
  1. 1.Department of OrthopedicsLucile Packard Children’s HospitalPalo AltoUSA
  2. 2.Pediatric Orthopedics and Scoliosis DivisionRady Children’s HospitalSan DiegoUSA

Personalised recommendations