CLINICO-RADIOLOGICAL PROFILE OF DEVELOPMENTAL DYSPLASIA OF HIP (DDH) IN INFANTS ATTENDING A TERTIARY CARE CENTER.
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Keywords
Developmental Dysplasia of the Hip, DDH, Ortolani manoeuvre, Barlow manoeuvre, Graf classification, acetabular index, late presentation
Abstract
BackgroundDevelopmental Dysplasia of the Hip (DDH) is a widely occurring paediatric musculoskeletal disease whose aetiology is multi-factorial, with a diverse presentation. In developing countries such as India, late diagnosis is still widespread because of the limited screening facilities. This paper set out to characterize the clinico-radiological picture of DDH among the infants who present to a tertiary care unit in central India.
Methods A cross-sectional observational study at the hospital was carried out in 12 months (October 2021-September 2022) involving 50 infants with suspected DDH on the basis of clinical symptoms or risk factors. Clinical examination (Ortolani, Barlow, hip abduction, Galeazzi sign) and imaging (ultrasonography with Graf classification less than 6 months; pelvic radiographs with acetabular index more than 6 months) was done. The analysis of data was performed with the help of descriptive statistics and sensitivity calculations.
ResultsOf the 50 babies, 82% were female, 64% were first-born and 24% were presented with the breech. The most common clinical signs were limited hip abduction (76%), and asymmetric thigh folds (66%). In 60% (unilateral 84, bilateral 16), the left hip was affected. In 68 ultrasonography demonstrated Graf Type III/IV (severe), and radiographs demonstrated acetabular index 30 or more degrees and >40 or more degrees, respectively 88 and 32, respectively. Sensitivity of Barlow manoeuvre 72/2, and that of Ortolani manoeuvre 44/2, was associated with late presentation with irreducible dislocations.
ConclusionIn this context the frequency of late presenting severe DDH is the most common, and clinical manoeuvres (particularly the Ortolani) and complex radiological dysplasia is not well sensitive to diagnosis. To enhance early diagnosis and resulting provision in resource limited areas, targeted ultrasound screening of the infants of the high risk population, compulsory clinical examination and community education are necessary.
References
2. Dezateux C, Rosendahl K. Developmental dysplasia of the hip. Lancet. 2007;369(9572):1541–52.
3. Karnik A, Lawande A, Lawande MA, Patkar D, Aroojis A, Bhatnagar N. Practice essentials of imaging in early diagnosis of DDH. Indian J Orthop. 2021;55(6):1466–79.
4. Loder RT, Skopelja EN. The epidemiology and demographics of hip dysplasia. ISRN Orthop. 2011;2011:238607.
5. Ömeroglu H. Treatment of developmental dysplasia of the hip with the Pavlik harness in children under six months of age: indications, results and failures. J Child Orthop. 2018;12(4):308–16.
6. Aronsson DD, Goldberg MJ, Kling TF Jr, Roy DR. Developmental dysplasia of the hip. Pediatrics. 1994;94(2 Pt 1):201–8.
7. Castelein RM, Sauter AJ. Ultrasound screening for congenital dysplasia of the hip in newborns: its value. J Pediatr Orthop. 1988;8(6):666–70.
8. Pun S. Hip dysplasia in the young adult caused by residual childhood and adolescent-onset dysplasia. Curr Rev Musculoskelet Med. 2016;9(4):427–34.
9. Danielsson L. Late-diagnosed DDH: a prospective 11-year follow-up of 71 consecutively treated children with late-diagnosed developmental dysplasia of the hip. J Pediatr Orthop B. 2000;9(1):7–11.
10. Sankar WN, Neubuerger CO, Moseley CF. Femoral head avascular necrosis following Pavlik harness treatment of developmental dysplasia of the hip. J Pediatr Orthop. 2009;29(5):568–71.
11. Kyung BS, Lee SH, Jeong WK, Park SY. Disparity between clinical and ultrasound examinations in neonatal hip screening. Clin Orthop Surg. 2016;8(2):203–9.
12. Rosendahl K, Markestad T, Lie RT. Ultrasound screening for developmental dysplasia of the hip in the neonate: the effect on treatment rate and prevalence of late cases. Pediatrics. 1994;94(1):47–52.
13. Clarke NM, Reading IC, Corbin C, Taylor CC, Bochmann T. Twenty years experience of selective secondary ultrasound screening for congenital dislocation of the hip. Arch Dis Child. 2012;97(5):423–9.
14. Biedermann R, Eastwood DM. Universal or selective ultrasound screening for developmental dysplasia of the hip? A discussion of the key issues. J Child Orthop. 2018;12(4):296–301.
15. von Kries R, Ihme N, Oberle D, et al. Effect of ultrasound screening on the rate of first operative procedures for developmental hip dysplasia in Germany. Lancet. 2003;362(9399):1883–7.
16. Hooper N, Aroojis A, Narasimhan R, et al. Developmental dysplasia of the hip: an examination of care practices of orthopaedic surgeons in India. Indian J Orthop. 2021;55(1):158–68.
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Dr Satendra Singh Rajput
Assistant professor , Department of pediatrics , Gajra Raja Medical College, Gwalior.
Dr Priyanka Rajput
Demonstrator, Department of Physiology , Gajra Raja Medical College, Gwalior.
Dr Ritesh Singh Yadav
Assistant Professor, Department OfOrthopaedic , Index Medical College Malwanchal University, Indore.
Dr Ramniwas. Mahore
Assistant Professor, Community Medicine Department, Gajra Raja Medical College, Gwalior.
