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Disparity between Clinical and Ultrasound Examinations in Neonatal Hip Screening

BACKGROUND: For early detection of developmental dysplasia of the hip (DDH), neonatal hip screening using clinical examination and/or ultrasound has been recommended. Although there have been many studies on the reliability of both screening techniques, there is still controversy in the screening st...

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Autores principales: Kyung, Bong Soo, Lee, Soon Hyuck, Jeong, Woong Kyo, Park, Si Young
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Orthopaedic Association 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870325/
https://www.ncbi.nlm.nih.gov/pubmed/27247747
http://dx.doi.org/10.4055/cios.2016.8.2.203
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author Kyung, Bong Soo
Lee, Soon Hyuck
Jeong, Woong Kyo
Park, Si Young
author_facet Kyung, Bong Soo
Lee, Soon Hyuck
Jeong, Woong Kyo
Park, Si Young
author_sort Kyung, Bong Soo
collection PubMed
description BACKGROUND: For early detection of developmental dysplasia of the hip (DDH), neonatal hip screening using clinical examination and/or ultrasound has been recommended. Although there have been many studies on the reliability of both screening techniques, there is still controversy in the screening strategies; clinical vs. selective or universal ultrasound screening. To determine the screening strategy, we assessed the agreement among the methods; clinical examination by an experienced pediatric orthopedic surgeon, sonographic morphology, and sonographic stability. METHODS: From January 2004 to June 2009, a single experienced pediatric orthopedic surgeon performed clinical hip screenings for 2,686 infants in the neonatal unit and 43 infants who were referred due to impressions of hip dysplasia before 3 months of age. Among them, 156 clinically unstable or high-risk babies selectively received bilateral hip ultrasound examinations performed by the same surgeon using the modified Graf method. The results were analyzed statistically to detect any correlations between the clinical and sonographic findings. RESULTS: Although a single experienced orthopedic surgeon conducted all examinations, we detected only a limited relationship between the results of clinical and ultrasound examinations. Ninety-three percent of the clinically subluxatable hips were normal or immature based on static ultrasound examination, and 74% of dislocating hips and 67% of limited abduction hips presented with the morphology below Graf IIa. A total of 80% of clinically subluxatable, 42% of dislocating and 67% of limited abduction hips appeared stable or exhibited minor instability on dynamic ultrasound examination. About 7% of clinically normal hips were abnormal upon ultrasound examination; 5% showed major instability and 3% showed dysplasia above Graf IIc. Clinical stability had small coefficients between ultrasound examinations; 0.39 for sonographic stability and 0.37 for sonographic morphology. Between sonographic stability and morphology, although 71% of hips with major instability showed normal or immature morphology according to static ultrasound examination, the coefficient was as high as 0.64. CONCLUSIONS: Discrepancies between clinical and ultrasound examinations were present even if almost all of the exams were performed by a single experienced pediatric orthopedic surgeon. In relation to screening for DDH, it is recommended that both sonographic morphology and stability be checked in addition to clinical examination.
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spelling pubmed-48703252016-06-01 Disparity between Clinical and Ultrasound Examinations in Neonatal Hip Screening Kyung, Bong Soo Lee, Soon Hyuck Jeong, Woong Kyo Park, Si Young Clin Orthop Surg Original Article BACKGROUND: For early detection of developmental dysplasia of the hip (DDH), neonatal hip screening using clinical examination and/or ultrasound has been recommended. Although there have been many studies on the reliability of both screening techniques, there is still controversy in the screening strategies; clinical vs. selective or universal ultrasound screening. To determine the screening strategy, we assessed the agreement among the methods; clinical examination by an experienced pediatric orthopedic surgeon, sonographic morphology, and sonographic stability. METHODS: From January 2004 to June 2009, a single experienced pediatric orthopedic surgeon performed clinical hip screenings for 2,686 infants in the neonatal unit and 43 infants who were referred due to impressions of hip dysplasia before 3 months of age. Among them, 156 clinically unstable or high-risk babies selectively received bilateral hip ultrasound examinations performed by the same surgeon using the modified Graf method. The results were analyzed statistically to detect any correlations between the clinical and sonographic findings. RESULTS: Although a single experienced orthopedic surgeon conducted all examinations, we detected only a limited relationship between the results of clinical and ultrasound examinations. Ninety-three percent of the clinically subluxatable hips were normal or immature based on static ultrasound examination, and 74% of dislocating hips and 67% of limited abduction hips presented with the morphology below Graf IIa. A total of 80% of clinically subluxatable, 42% of dislocating and 67% of limited abduction hips appeared stable or exhibited minor instability on dynamic ultrasound examination. About 7% of clinically normal hips were abnormal upon ultrasound examination; 5% showed major instability and 3% showed dysplasia above Graf IIc. Clinical stability had small coefficients between ultrasound examinations; 0.39 for sonographic stability and 0.37 for sonographic morphology. Between sonographic stability and morphology, although 71% of hips with major instability showed normal or immature morphology according to static ultrasound examination, the coefficient was as high as 0.64. CONCLUSIONS: Discrepancies between clinical and ultrasound examinations were present even if almost all of the exams were performed by a single experienced pediatric orthopedic surgeon. In relation to screening for DDH, it is recommended that both sonographic morphology and stability be checked in addition to clinical examination. The Korean Orthopaedic Association 2016-06 2016-05-10 /pmc/articles/PMC4870325/ /pubmed/27247747 http://dx.doi.org/10.4055/cios.2016.8.2.203 Text en Copyright © 2016 by The Korean Orthopaedic Association http://creativecommons.org/licenses/by-nc/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Kyung, Bong Soo
Lee, Soon Hyuck
Jeong, Woong Kyo
Park, Si Young
Disparity between Clinical and Ultrasound Examinations in Neonatal Hip Screening
title Disparity between Clinical and Ultrasound Examinations in Neonatal Hip Screening
title_full Disparity between Clinical and Ultrasound Examinations in Neonatal Hip Screening
title_fullStr Disparity between Clinical and Ultrasound Examinations in Neonatal Hip Screening
title_full_unstemmed Disparity between Clinical and Ultrasound Examinations in Neonatal Hip Screening
title_short Disparity between Clinical and Ultrasound Examinations in Neonatal Hip Screening
title_sort disparity between clinical and ultrasound examinations in neonatal hip screening
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870325/
https://www.ncbi.nlm.nih.gov/pubmed/27247747
http://dx.doi.org/10.4055/cios.2016.8.2.203
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