Abstract
Background and purpose — Current selective screening algorithms for developmental dysplasia of the hip (DDH) are insufficient. Universal screening programs have been proposed but so far have been deemed too expensive and time consuming. The pubo-femoral distance may solve this problem as a quick, low-cost, highly sensitive, and specific sonographic measurement for DDH, but this has only been validated in the supine position. Therefore we validated pubo-femoral distance (PFD) in the lateral position as an indicator for instability of the hip.Methods — All participants had undergone ultrasonographic diagnostics using the modified Graf technique. In addition, PFD measurements in lateral position were performed. Results were compared between 25 infants who had been treated for DDH because of dysplastic appearance on ultrasound combined with clinical instability and a control group consisting of 100 untreated infants screened for DDH. Sensitivity, specificity, and cut-off points were determined using Receiver operating characteristics (ROC) analysis.Results — We found a mean PFD of 6.8 mm (6.2–7.4) in the treated group with a control group PFD of 3.4 mm (3.3–3.6) (p < 0.005). A PFD value above a threshold of 4.4 mm yielded a sensitivity of 100% and a specificity of 93% for detecting unstable DDH.Interpretation — PFD measured in lateral position was statistically significantly increased in hips of children treated for DDH with Denis Browne hip brace compared with healthy children with unaffected stable hips. Furthermore, the PFD measurement had a high level of sensitivity and specificity at a cut-off value of 4.4 mm. A cut-off value of 6.00 mm has previously been reported as the gold standard in supine position. We suggest that 4.4 mm is used in lateral position.
Highlights
Interpretation — pubo-femoral distance (PFD) measured in lateral position was statistically significantly increased in hips of children treated for developmental dysplasia of the hip (DDH) with Denis Browne hip brace compared with healthy children with unaffected stable hips
Interpretation — PFD measured in lateral position was statistically significantly increased in hips of children treated for DDH with Denis Browne hip brace compared with healthy children with unaffected stable hips
Universal ultrasound screening decreases the rate of late diagnosis and surgical interventions, and is cost-effective (Thaler et al 2011) as well as useful in detecting developmental dysplasia of the hip (DDH) in children with no apparent clinical symptoms or risk factors (Marks et al 1994)
Summary
Interpretation — PFD measured in lateral position was statistically significantly increased in hips of children treated for DDH with Denis Browne hip brace compared with healthy children with unaffected stable hips. Children with established risk factors for the development of DDH (breech presentation, 1 degree relative to DDH, oligohydramnios, congenital deformities), bypass the general screening program, and are referred to ultrasound examination directly by the midwife. These infants are screened for DDH with a combination of clinical examination of the hip instability and ultrasound using a modified Graf technique (Graf 1983). Treguier et al (2013) have implemented the pubo-femoral distance (PFD) measured in supine position, as developed by Couture et al (2011), in a screening program in France This is a simple measurement to detect hip instability and identify at-risk hips where early intervention is warranted
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