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Comparative Study
. 2008 Jun;32(3):415-9.
doi: 10.1007/s00264-007-0333-x. Epub 2007 Mar 1.

Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip

H Dogruel  1 , H Atalar, O Y Yavuz, U Sayli
Affiliations
Comparative Study

Clinical examination versus ultrasonography in detecting developmental dysplasia of the hip

H Dogruel et al. Int Orthop. 2008 Jun.

Abstract
in English, French

Although hip ultrasonography is gaining acceptance as the most effective method for the early diagnosis of developmental dysplasia of the hip, there is still some controversy regarding the use of ultrasonography as a screening method. The purpose of this study was to investigate prospectively the capacity of clinical examination findings and associated risk factors to detect developmental dysplasia of the hip defined ultrasonographically in infants. A total of 3,541 infants underwent clinical examination and hip ultrasonography. Measured against ultrasonography as a standard, the sensitivity and specificity of clinical examination were 97% and 13.68%, respectively. Graf type IIb or more severe developmental dysplasia was found in 167 infants (208 hips), at an overall frequency of 4.71%. Graf type IIa physiological immaturity was encountered in 838 hips, and of these, 15 hips (1.78%) developed Graf type IIb dysplasia and underwent treatment. Patient characteristics that were found to be significant risk factors were swaddling use, female gender, breech delivery and positive family history. Given its low specificity, our findings suggest that clinical examination does not reliably detect ultrasonographically defined developmental dysplasia of the hip in infants being screened for this disease.

Si l’échographie est une méthode efficace pour le diagnostic précoce des dysplasie ou des luxations de hanches, son utilisation comme méthode de dépistage est controversée. Le propos de cette étude est de réaliser une étude prospective de cet examen à partir de patients présentant des facteurs de risques et d’un examen clinique (3,541 enfants). La sensibilité et la spécificité de l’examen clinique a été respectivement de 97% et 13.68%. Cent soixante-sept enfants (208 hanches) présentaient soit un type IIb de Graf ou une atteinte plus sévère soit 4.71%. Une hanche immature avec un type IIa de Graf a été présente dans 838 hanches, 15 d’entre-elles (1.78%) évoluant vers le type IIb et nécessitant un traitement. Les facteurs de risques utilisés ont été les suivants : sexe féminin, antécédent, siège. Du fait de cette spécificité basse de l’examen, nous pensons que l’examen clinique ne permet pas de mettre en évidence de façon certaine les stades de dysphonies détectés à l’échographie de la hanche chez les enfants ainsi dépistés.

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References

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