Role of Dynamic Ultrasound Scan in Detection of Hip Instability and Changing Management Plan

Abstract

Objectives: To show the vital role of dynamic ultrasound in hip instability screening and review the management plans available for DDH associated with instability with a view to reduce the incidence of complication from delayed diagnosis in our region. Place and Duration of the study: Helena governmental rehabilitation center for children with special needs, Erbil-Iraq, between Nov’21 to Jan’23. Material and Method: This study included 942 infants’ hips presenting with high-risk indicators or a positive clinical examination ranging in age from 6 weeks to 6 months. We performed the ultrasonography using the static Graf technique to determine the DDH Types and then apply the dynamic scan to find stability using Moren-Terjesen’s and Harcke methods. The management approaches were conducted considering both techniques. We used SPSS version 28 along with Chi-square test for data analysis and comparison of proportions. Results: In this retrospective cross-sectional study of 942 hips, the mean age of the infants was 11.9±4.8 weeks with male to female percentage of 46% to 54%. We found a correlation between family history and breech presentation to the dynamic scan stability. In the Graf technique 55% showed the absence of dysplasia while the dynamic scan showed 66% of the hips as normal and 34% as unstable. Further, the significant statistical association (P= 0.001) between the results of dynamic scan stability to the effect on the management plan was also found to advise the change for the unstable hips. Conclusion: It is crucial to apply both static and dynamic scans in the screening of DDH, so that we can reduce the possibility of late detection and elevate the level of diagnostic accuracy. We should follow a strict guideline for the management of all DDH cases (stable and unstable) and change the plan accordingly.