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A Method to Increase Early Detection of Congenital Dysplasia of the Hip

Robert S. Walter, MD; James S. Donaldson, MD; Cheryl L. Davis, MD; Arnold Shkolnik, MD; Helen J. Binns, MD; Norris C. Carroll, MD; Robert T. Brouillette, MD

Am J Dis Child. 1992;146(2):230-234.

Abstract
• Congenital dysplasia of the hip (CDH) continues to be missed by routine physical screening examinations in the early months when treatment is most effective. Real-time ultrasonography (US) is valuable in the detection of CDH in the young infant. We performed a prospective study to evaluate one US screening strategy that targets a select "high-risk newborn" population at risk for CDH aiming to increase the early diagnosis of this condition. From 1772 consecutive births at one hospital, we identified 97 (5.5%) newborns with risk factors for CDH: breech delivery, 73 babies; family history, 26 babies; postural abnormalities, five babies; and oligohydramnios, four babies. Eleven newborns had two risk factors. We studied 69 of these newborns with US. There were four cases of CDH in this group. Three of these babies had completely normal pediatric physical examination results at the time of the US study (at 14, 75, and 100 days, respectively) despite dysplasia diagnosed by US. All were successfully treated with a harness as outpatients. We conclude that a screening program entailing identification and subsequent US of the hip of newborns with specific physical and historical risk factors for CDH increases early diagnosis. Further analysis suggests this approach is cost-effective.

(AJDC. 1992;146:230-234)

Author Affiliations
From the Department of Pediatrics (Dr Walter), A. I. duPont Institute, Division of General Pediatrics, Wilmington, Del; the Departments of Radiology (Drs Donaldson and Shkolnik), Pediatrics (Drs Davis and Binns), and Orthopedics (Dr Carroll), Children's Memorial Hospital, Prentice Women's Hospital, and Northwestern University Medical School, Chicago, Ill; and the Department of Pediatrics (Dr Brouillette), McGill University, Montreal Children's Hospital, Newborn Medicine, Montreal, Quebec.

Footnotes
Accepted for publication September 20, 1991.

Read before the 32nd Annual Meeting of the Society for Pediatric Radiology, San Antonio, Tex, April 8,1989. Presented as a poster exhibit at the Society for Pediatric Research, Washington, DC, May 1, 1989. Read before the Canadian Orthopedic Association, Toronto, Ontario, May 29, 1989.

Reprint requests to A. I. duPont Institute, Division of General Pediatrics, 1600 Rockland Rd, PO Box 269, Wilmington, DE 19899 (Dr Walter).

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