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Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip

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Abstract

Although hip ultrasonography is gaining acceptance as the most effective method for the early diagnosis of developmental dysplasia of the hip, there is still some controversy regarding the use of ultrasonography as a screening method. The purpose of this study was to investigate prospectively the capacity of clinical examination findings and associated risk factors to detect developmental dysplasia of the hip defined ultrasonographically in infants. A total of 3,541 infants underwent clinical examination and hip ultrasonography. Measured against ultrasonography as a standard, the sensitivity and specificity of clinical examination were 97% and 13.68%, respectively. Graf type IIb or more severe developmental dysplasia was found in 167 infants (208 hips), at an overall frequency of 4.71%. Graf type IIa physiological immaturity was encountered in 838 hips, and of these, 15 hips (1.78%) developed Graf type IIb dysplasia and underwent treatment. Patient characteristics that were found to be significant risk factors were swaddling use, female gender, breech delivery and positive family history. Given its low specificity, our findings suggest that clinical examination does not reliably detect ultrasonographically defined developmental dysplasia of the hip in infants being screened for this disease.

Résumé

Si l’échographie est une méthode efficace pour le diagnostic précoce des dysplasie ou des luxations de hanches, son utilisation comme méthode de dépistage est controversée. Le propos de cette étude est de réaliser une étude prospective de cet examen à partir de patients présentant des facteurs de risques et d’un examen clinique (3,541 enfants). La sensibilité et la spécificité de l’examen clinique a été respectivement de 97% et 13.68%. Cent soixante-sept enfants (208 hanches) présentaient soit un type IIb de Graf ou une atteinte plus sévère soit 4.71%. Une hanche immature avec un type IIa de Graf a été présente dans 838 hanches, 15 d’entre-elles (1.78%) évoluant vers le type IIb et nécessitant un traitement. Les facteurs de risques utilisés ont été les suivants : sexe féminin, antécédent, siège. Du fait de cette spécificité basse de l’examen, nous pensons que l’examen clinique ne permet pas de mettre en évidence de façon certaine les stades de dysphonies détectés à l’échographie de la hanche chez les enfants ainsi dépistés.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Güven Hospital, Ankara, Turkey

    H. Dogruel

  2. Department of Orthopaedic Surgery, Fatih University, Ankara, Turkey

    H. Atalar & O. Y. Yavuz

  3. Department of Orthopaedic Surgery, A Klinik, Ankara, Turkey

    U. Sayli

Authors
  1. H. Dogruel
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  2. H. Atalar
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  3. O. Y. Yavuz
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  4. U. Sayli
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Corresponding author

Correspondence to H. Dogruel.

Additional information

This study was conducted at Fatih University Hospital, Ankara, Turkey.

No funds have been received to support this study.

Our institution’s ethics committee approved this study.

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Dogruel, H., Atalar, H., Yavuz, O.Y. et al. Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip. International Orthopaedics (SICO 32, 415–419 (2008). https://doi.org/10.1007/s00264-007-0333-x

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  • DOI: https://doi.org/10.1007/s00264-007-0333-x

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