Diagnosis of DDH PDF Print E-mail

Diagnosis

More recent specialist literature considers ultrasound screening  and clinical examination of neonates as early as possible to be ideal.

There are two methods of CDH diagnostics In newborns: clinical examination and ultrasonsound  introduced by prof.Graf in 1978.
Each of these methods has some advantages and drawbacks. The ability of applying both of them enabless to discover every abnormality in the hip joint structure. Despite better and better clinical examination techniques to find clinical hip Instability by the Ortolani   and Barlow tests( provoked stabilisation and dislocation) ) pict1,2 ;  only 10% of CDH is discovered but 30% is false positive, and 5% of them need operative treatment, so effects of such screening are not satisfying.

Their prognosis may be worse for the babies with CDH  than that before screening began,because the diagnosis is not suspected by their parents, doctors and health workers who believe that neonatal screening is fully effective.

Not gentle and too long clinical examination may laso lead to worsening of defect through mechanical damages and blood supply disturances in femoral head. Clinical examination also lasts much more longer (even up to almost an hour)than ultrasound, which lasts only several seconds and it totally safe for patient.


Contraction of hip muscles pict3(until recently the only indication in the diagnosis of DDH currently of little importance in the diagnosis according to the latest American research) occurs to a various degree in 10 per cent of all infants,however,only a small percentage (18%)is caused by an abnormal hip joint

Only an ultrasound examination of the hips enables a detailed  noninvasive diagnosis of the smallest anomaly in the infant’s hip joint.

Only sufficiently qualified orthopedists  can both establish the usg diagnosis of malformations in hip structure and can distinguish which disturbances require treatment, and which require onlyobservation and prophylaxis. So only qualifield orthopedists should perform examinations.  Examinations done by poorly qualified doctors lead either to a great number of hip joint disease diagnose (which is more frequent because it is easier) or to omitting it. Especially these examinations should not be performed by medical technicians, because hip  ultrasonography is a dynamic examination and hip assessment takes place during treatment a minimal movement of an infant or usg warhead creates changes in the image, and the disorder of hip joint can be found even if there is no hip defect at all.

Part of improper and not-diagnosed hips are symptomless. Part of hips with shallow acetabulum reveal no symptoms over many years, until joint destruction followed by pain,when it is too late for prevention .

The ultrasound hip screening by a qualified doctor is a standard procedure in highly developed countries such as Germany,Switzerland Austria,which achive four time better results of treatment ( at present  the best ever results in the world) than countries which do not apply obligatory ultrasound examinations

Due to limited expenses of public health service and Lack of appropriately qualified doctor, decision about hip ultrasonography in neonatal ward should belong to parents, who in majority of cases, decide to perform hip usg, even if they have to pay for it additionally. They increase the chances of their child for health hip. Cost of single examination is lower than complaints and costs caused by hip insufficiency due to DDH.

Pict.1 Barlow test

 

Pict.2 OrtolaniTest

 

 

Pict.4 Contracure Test