The validity of clinical examination in screening of developmental dysplasia of the hip among infants aged less than six months

Abstract

Background and objectives: Developmental dysplasia of the hip is a challenging condition, requiring screening for early diagnosis. This study was conducted to assess the validity of clinical screening tests of developmental dysplasia of the hip among infants aged less than 6 months. Methods: A cross-sectional study conducted at the center of early detection of childhood disability, Duhok City, Iraq for the period from April 2018 to February 2019. A convenience sample of 100 infants aged less than 6 months, who were referred to orthopedic surgeon in this center were included. Three clinical examination tests were conducted followed by ultrasonography of the hip joints. Results: Out of 100 infants, 59 (59%) were detected by ultrasonography to have Developmental Dysplasia of the Hip; 39% had unilateral and 20% bilateral ones. Barlow test was found to have the highest sensitivity, 49.15%, with a specificity of 85.37%, positive predictive value was 82.86%, and negative predictive value was 53.85%, compared to that of Ortolani test: 30.51%, 82.93%, 72.0%, and 45.33%, respectively. Galeazzi test reported to have the lowest sensitivity (8.47%), with both specificity and positive predictive value of 100%, and negative predictive value of 43.15%. Female gender was significantly associated with Developmental Dysplasia of the Hip in infants, with female to male ratio of 1.6:1. Conclusions: Barlow test is the clinical test of the highest sensitivity and good specificity for the screening of infant Developmental Dysplasia of the Hip. Because of the high false negative results of the three clinical screening tests, further assessment with ultrasound is recommended.