Abstract
Aim Risk based screening for developmental dysplasia of the hip (DDH) with ultrasound is common. However, risk factors vary from one country to the other since data are insufficient to give clear recommendations. We aimed to evaluate the risk factors for developmental dysplasia of the hip (DDH). Methods In this retrospective case-control study, the health records of all children, who were followed up between 2004 and 2014 at a well-child unit, were investigated for the diagnosis of DDH in Turkey. Of 9758 children, 57 children were found to have abnormal ultrasonographic findings (according to Graf classification) and these constituted the case group. As the control group, healthy 228 children who matched the case children in birth months were selected. Two groups were compared for the risk factors. Results A total of 19516 hips of 9758 children were examined for DDH. 97 hips of 57 children were found to have abnormal ultrasonographic findings. When the two groups were compared, breech presentation, multiple pregnancy, and torticollis were identified as risk factors. The female sex was also found to have a significantly high prevalence among the children in the case group. Limited hip abduction, positive Ortolani, and Barlow signs were important clinical findings in the case group. Conclusion According to our findings, breech presentation, female sex, torticollis, and multiple pregnancy were found to be the risk factors of this disorder. Infants with these risk factors should be investigated carefully for DDH.
Highlights
Screening programs for developmental dysplasia of the hip (DDH) have been present for many years
Age appropriate imaging is recommended by the American Academy of Pediatrics for female infants born breech or with family history of DDH [2]
In the United Kingdom, clinical hip instability in physical examination, family history of first degree relative requiring DDH treatment, breech position, multiple births if any of the babies is breech presentation are seen as risks requiring ultrasonographic investigation [3]
Summary
Different programs include pure clinical examination, selective ultrasonographic screening of at-risk newborns or universal neonatal ultrasonographic screening [1]. In the United Kingdom, clinical hip instability in physical examination, family history of first degree relative requiring DDH treatment, breech position, multiple births if any of the babies is breech presentation are seen as risks requiring ultrasonographic investigation [3]. The screening of all newborns at birth for DDH using ultrasound imaging is standard practice in Germany, Austria, and Switzerland [4]. All neonates with family history of DDH up to third-degree relatives, oligo/hydoamnios, breech presentation, foot deformities, plagiocephaly, scoliosis, congenital muscular torticollis (CMT), pelvic obliquity, adduction contracture of the hip, multiple pregnancy, and firstborn girl of the family are referred for ultrasound scanning [5]
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