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Exploration of femoral head coverage in screening developmental dysplasia of the hip in infants

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Abstract

Purpose

To investigate the relationship of femoral head coverage (FHC) with Graf’s classification for diagnosis of developmental dysplasia of the hip (DDH) and its role in evaluating hip stability.

Methods

A total of 4222 hips were screened ultrasonographically with Graf’s and Harcke’s methods. The stability of hips was analyzed using the difference between FHCs at neutral and flexion positions (FHC-D).

Results

(1) For the non-dislocated hips, the mean value of FHC at the neutral position was 59.4%, which was significantly greater than 55.0% of FHC at the flexion position (p < 0.001). (2) FHC at the neutral position corresponding to Graf I, IIa/b, IIc, D, III, and IV was 63.0 ± 4.7%, 57.0 ± 5.2%, 49.5 ± 5.5%, 37.7 ± 3.7%, 30.2 ± 12.7%, and 7.4 ± 11.9%, respectively, and that at the flexion position was 59.0 ± 4.4%, 50.7 ± 9.4%, 35.2 ± 5.2%, 30.8 ± 1.3%, 23.4 ± 10.7%, and 4.7 ± 9.9%, respectively, showing a statistically significant difference between the two positions. (3) The AUC of FHC-D in evaluating the stability of hips was 0.972. When the threshold was 8.5%, the sensitivity, specificity, and accuracy of FHC-D in detecting hip instability were 89.0%, 93.0%, and 93.9%, respectively.

Conclusions

FHC can be used as a reference indicator for DDH classification. FHC at different positions corresponds to different reference values, and FHC-D can be used as a quantitative indicator for assessment of hip stability.

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References

  1. Dezateux C, Rosendahl K. Developmental dysplasia of the hip. Lancet. 2007;369:1541–52.

    Article  PubMed  Google Scholar 

  2. Sewell MD, Rosendahl K, Eastwood DM. Developmental dysplasia of the hip. BMJ. 2009;339:1242–8.

    Article  Google Scholar 

  3. Teixeira SR, Dalto VF, Maranho DA, et al. Comparison between Graf method and pubo-femoral distance in neutral and flexion positions to diagnose developmental dysplasia of the hip. Eur J Radiol. 2015;84:301–6.

    Article  PubMed  Google Scholar 

  4. Graf R. The use of ultrasonography in developmental dysplasia of the hip. Acta Orthop Traumatol Turc. 2007;41:6–13.

    PubMed  Google Scholar 

  5. Hell AK, Becker JC, Rühmann O, et al. Inter- and intraobserver reliability in Graf’s sonographic hip examination. Z Orthop Unfall. 2008;146:624–9.

    Article  CAS  PubMed  Google Scholar 

  6. Harcke HT, Kumar SJ. The role of ultrasound in the diagnosis and management of congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1991;73:622–8.

    Article  CAS  PubMed  Google Scholar 

  7. Graf R, Mohajer M, Plattner F. Hip sonography update. Quality-management, catastrophes-tips and tricks. Med Ultrason. 2013;15:299–303.

    Article  PubMed  Google Scholar 

  8. Harcke HT, Grissom LE. Performing dynamic sonography of the infant hip. AJR Am J Roentgenol. 1990;155:837–44.

    Article  CAS  PubMed  Google Scholar 

  9. AIOUI Medicine. AIUM practice guideline for the performance of an ultrasound examination for detection and assessment of developmental dysplasia of the hip. J Ultrasound Med. 2013;32:1307–17.

    Article  Google Scholar 

  10. Morin C, Harcke HT, MacEwen GD. The infant hip: real-time US assessment of acetabular development. Radiology. 1985;157:673–7.

    Article  CAS  PubMed  Google Scholar 

  11. Terjesen T, Bredland T, Berg V. Ultrasound for hip assessment in the newborn. J Bone Joint Surg Br. 1989;71:767–73.

    Article  CAS  PubMed  Google Scholar 

  12. Gunay C, Atalar H, Dogruel H, et al. Correlation of femoral head coverage and Graf alpha angle in infants being screened for developmental dysplasia of the hip. Int Orthop. 2009;33:761–4.

    Article  CAS  PubMed  Google Scholar 

  13. Rosendahl K, Markestad T, Lie RT. Ultrasound in the early diagnosis of congenital dislocation of the hip: the significance of hip stability versus acetabular morphology. Pediatr Radiol. 1992;22:430–3.

    Article  CAS  PubMed  Google Scholar 

  14. Alexiev VA, Harcke HT, Kumar SJ. Residual dysplasia after successful Pavlik harness treatment: early ultrasound predictors. J Pediatr Orthop. 2006;26:16–23.

    Article  PubMed  Google Scholar 

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Correspondence to Wei Fan.

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The authors declare that they have no conflicts of interest.

Ethical statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent was obtained from all patients for being included in the study.

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Fan, W., Li, Xj., Gao, H. et al. Exploration of femoral head coverage in screening developmental dysplasia of the hip in infants. J Med Ultrasonics 46, 129–135 (2019). https://doi.org/10.1007/s10396-018-0911-0

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  • DOI: https://doi.org/10.1007/s10396-018-0911-0

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