Erschienen in:
01.04.2014 | Original Article
Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1991–2006
verfasst von:
Lene Bjerke Laborie, Trond Jacob Markestad, Henrik Davidsen, Kari Røine Brurås, Stein Magnus Aukland, John Asle Bjørlykke, Hallvard Reigstad, Kari Indrekvam, Trude Gundersen Lehmann, Ingvild Øvstebø Engesæter, Lars Birger Engesæter, Karen Rosendahl
Erschienen in:
Pediatric Radiology
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Ausgabe 4/2014
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Abstract
Background
Early treatment is considered essential for developmental dysplasia of the hip (DDH), but the choice of screening strategy is debated.
Objective
We evaluated the effect of a selective ultrasound (US) screening programme.
Materials and methods
All infants born in a defined region during 1991–2006 with increased risk of developmental dysplasia of the hip, i.e. clinical hip instability, breech presentation, congenital foot deformities or a family history of DDH, underwent US screening at age 1–3 days. Severe sonographic dysplasia and dislocatable/dislocated hips were treated with abduction splints. Mild dysplasia and pathological instability, i.e. not dislocatable/dislocated hips were followed clinically and sonographically until spontaneous resolution, or until treatment became necessary. The minimum observation period was 5.5 years.
Results
Of 81,564 newborns, 11,539 (14.1%) were identified as at-risk, of whom 11,190 (58% girls) were included for further analyses. Of the 81,564 infants, 2,433 (3.0%) received early treatment; 1,882 (2.3%) from birth and 551 (0.7%) after 6 weeks or more of clinical and sonographic surveillance. An additional 2,700 (3.3%) normalised spontaneously after watchful waiting from birth. Twenty-six infants (0.32 per 1,000, 92% girls, two from the risk group) presented with late subluxated/dislocated hips (after 1 month of age). An additional 126 (1.5 per 1,000, 83% girls, one from the risk group) were treated after isolated late residual dysplasia. Thirty-one children (0.38 per 1,000) had surgical treatment before age 5 years. Avascular necrosis was diagnosed in seven of all children treated (0.27%), four after early and three after late treatment.
Conclusion
The first 16 years of a standardised selective US screening programme for developmental dysplasia of the hip resulted in acceptable rates of early treatment and US follow-ups and low rates of late subluxated/dislocated hips compared to similar studies.