GRAF METHOD ULTRASOUND SCREENING OF NEWBORNS FOR DEVELOPMENTAL DYSPLASIA OF HIP

Abstract

Developmental dysplasia of the hip (DDH) is a multifactorial and predominant developmental malformation of the musculoskeletal system in newborns. It is now believed that the hip is not only dislocated at birth, but the process of dislocation progresses after birth. Hence the disorder previously known as congenital dislocation of the hip is now correctly termed as the developmental dysplasia of the hip which can develop even after birth. The term developmental dysplasia of the hip involves an assortment of abnormalities ranging from shallow acetabulum to complete dislocation of the head of femur. Timing of the initial hip ultrasound can make this disorder easily treatable. Graf method hip ultrasound is advisable for early recognition of DDH. Identifying usefulness of ultrasound in early detection of DDH is extremely important for best functional outcomes. Early detection and management are essential because conservative treatment is often successful, but delayed diagnosis may demand complex surgical treatment, as it is a preventable and treatable condition. Objectives of study include, to assess early identification of the DDH in newborns, to correlate association of Barlow’s and Ortolani’s tests with ultrasound, and to identify the risk factors associated with the occurrence of DDH. Subjects meeting inclusion criteria were considered after acquiring ethical approval from ethical review committee of the respective hospitals. Informed consent was obtained from parents of all participants. A detailed history was taken from parents. After inspection of both legs for length and thigh folds, a clinical examination by Barlow and Ortolani's maneuver was performed followed by Graf method ultrasound of both hip joints on all neonates referred from OPD, admitted and delivered in the National Institute of Child Health, Fazaia Ruth Pfau Medical College, Zubaida Medical Center, and Bantava Anis Hospitals. Both clinical and ultrasonographic examinations were performed by the investigator and counter-checked by the consultant neonatologists and radiologists. Information regarding family history, presentation of the baby at birth, birth weight, duration of gestation, presence of oligohydramnios, mode of delivery, parity, gender, x ethnic background, co-existing musculoskeletal deformities, lower-limb malformations and multiple pregnancies was recorded in the subject evaluation proforma. Results of ultrasound examination, among the 230 hips that were assessed, 69.13 percent of the hips were found to be mature or immature but appropriate for age, whereas 30.86 percent of the hips were found to be pathological immature or pathological hips. The newborn babies were examined clinically by Barlow’s and Ortolani’s test. The data showed that out of 115 subjects (230 hips), these maneuvers were positive only in 6 hips of pathological types (type-lll & type-lV). A significant correlation was observed in the newborn subjects with breech presentation, first born and ethnicity for DDH with the ultrasound results of a pathological. Conclusions: Current study demonstrated that universal screening enabled us to identify DDH in a number of children who had normal clinical examinations and without risk factors, suggesting that a universal screening is preferable to a selective screening.