RESUMO
OBJECTIVES: Determine if a new teaching bundle targeting developmental dysplasia of the hip screening improved interns' examination skills across multiple pediatric residency programs. METHODS: This multicenter prospective cohort study included interns across 6 pediatric residency sites within the Academic Pediatric Association's Better Outcomes through Research for Newborns Network in 2022. Participants underwent a baseline hip examination assessment on models using a checklist derived from textbook descriptions of Galeazzi, Ortolani, and Barlow maneuvers before receiving a teaching bundle. Repeat testing occurred after instruction. Data were analyzed using t-test for continuous and χ2 test for categorical variables. Semistructured focus groups provided qualitative feedback regarding the teaching bundle. RESULTS: We enrolled 117 of 155 interns across 6 sites (76%) for participation in the teaching bundle. Only 2% of participants (n = 2) identified a positive Galeazzi sign at baseline, whereas 88% (n = 103, P < .001) did so on the postinstructional assessment. Although 27% of participants (n = 32) correctly identified a positive Barlow sign at baseline, 69% (n = 81, P < .001) did so on the postinstructional assessment. The ability to correctly detect a positive Ortolani sign increased from 22% (n = 26) to 92% (n = 108, P < .001). Fifteen interns participated in the semistructured focus groups, with resultant themes reinforcing the limited experience of the infant hip examination before this intervention and the positive impact of the teaching bundle. CONCLUSIONS: Most participants in this study did not have strong infant hip examination skills at entry into residency. A standardized teaching bundle significantly improved skills in examination technique and identifying abnormalities.
Assuntos
Competência Clínica , Internato e Residência , Exame Físico , Humanos , Estudos Prospectivos , Exame Físico/métodos , Exame Físico/normas , Recém-Nascido , Pediatria/educação , Feminino , Masculino , Displasia do Desenvolvimento do Quadril/diagnóstico , LactenteRESUMO
INTRODUCTION: Initiation of Pavlik harness treatment for developmental dysplasia of the hip (DDH) by 6 to 7 weeks of age predicts a higher rate of success. Child Opportunity Index (COI) 2.0 is a single metric designed to measure resources and conditions affecting children's healthy development. This study investigates COI in relation to the timing of DDH diagnosis. METHODS: This is a retrospective cohort study on patients younger than 4 years diagnosed with DDH between 2016 and 2023, treated with a Pavlik harness, rigid hip abduction orthosis, and/or surgery. Demographic and clinical data were recorded, including date of first diagnostic imaging. Patients with syndromes, congenital anomalies, or neuromuscular disorders and those referred with an unknown date of first diagnostic imaging were excluded. A subgroup analysis of patients diagnosed at ≤6 weeks ("early") and >6 weeks ("late") was conducted. Statewide COI scores (total, three domains) and categorical quintile scores (very low, low, moderate, high, and very high) were recorded. RESULTS: A total of 115 patients were included: 90 female infants (78%), with a median age of 32 days at diagnostic imaging. No notable difference was observed between median age at diagnosis for study patients in low or very low quintiles and those in moderate, high, or very high quintiles for COI total or domains. "Early" and "late" diagnosis subgroups did not differ markedly by COI total or domains, nor insurance type, race, or ethnicity. Subgroups differed markedly by race and insurance status. DISCUSSION: In an urban children's hospital, COI did not differ markedly between patients diagnosed with DDH by ≤6 weeks and >6 weeks. This is the first study to pose this question on DDH in a population with predominantly low/very low COI scores and public insurance, which may lead to unexpected results. Replicating the study in a different setting could yield different results. LEVEL OF EVIDENCE: III.
Assuntos
Displasia do Desenvolvimento do Quadril , Hospitais Pediátricos , Humanos , Feminino , Estudos Retrospectivos , Lactente , Masculino , Displasia do Desenvolvimento do Quadril/terapia , Displasia do Desenvolvimento do Quadril/diagnóstico , Displasia do Desenvolvimento do Quadril/diagnóstico por imagem , Pré-Escolar , Populações Vulneráveis , Aparelhos Ortopédicos , Recém-Nascido , Luxação Congênita de Quadril/terapia , Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/diagnóstico por imagem , Estudos de CoortesRESUMO
BACKGROUND: Developmental dysplasia of the hip (DDH) is a common childhood health complaint, whose etiology is multifactorial. The incidence of DDH is variable and higher in Tibet plateau. Here, we collected plasma samples and studied the metabolomics signatures of DDH. METHODS: Fifty babies were enrolled: 25 with DDH and 25 age-matched non-DDH healthy controls (HC group). We collected plasma samples, laboratory parameters and conducted untargeted metabolomics profiling. RESULTS: There are many differential metabolites among patients with DDH, including 4-ß-hydroxymethyl-4-α-methyl-5-α-cholest-7-en-3-beta-ol, ß-cryptoxanthin, α-tocopherol, taurocholic acid, glycocholic acid, 2-(3,4-dihydroxybenzoyloxy)-4,6-dihydroxybenzoate, arabinosylhypoxanthine, leucyl-hydroxyproline, hypoxanthine. The main differential metabolic pathways focused on primary bile acid biosynthesis, arginine and proline metabolism, phenylalanine metabolism, histidine metabolism, purine metabolism. CONCLUSIONS: To our knowledge, this is the first report of metabolomics profile in babies with DHH. By combining the α-tocopherol and taurocholic acid, we could achieve the differential diagnosis of DDH.
Assuntos
Displasia do Desenvolvimento do Quadril , Metabolômica , Feminino , Humanos , Lactente , Masculino , Metabolômica/métodos , Tibet , Displasia do Desenvolvimento do Quadril/diagnósticoRESUMO
OBJECTIVE: The UK falls behind other European countries in the early detection of developmental dysplasia of the hip (DDH) and screening strategies differ for early detection. Clinical detection of DDH is challenging and recognised to be dependent on examiner experience. No studies exist assessing the number of personnel currently involved in such assessments.Our objective was to review the current screening procedure by studying a cohort of newborn babies in one teaching hospital and assess the number of health professionals involved in neonatal hip assessment and the number of examinations undertaken during one period by each individual. METHODS: This was a retrospective observational study assessing all babies born consecutively over a 14-week period in 2020. Record of each initial baby check was obtained from BadgerNet. Follow-up data on ultrasound or orthopaedic outpatient referrals were obtained from clinical records. RESULTS: 1037 babies were examined by 65 individual examiners representing 9 different healthcare professional groups. The range of examinations conducted per examiner was 1-97 with a median of 5.5 examinations per person. 49% of individuals examined 5 or less babies across the 14 weeks, with 18% only performing 1 examination. Of the six babies (0.48%) treated for DDH, one was picked up on neonatal assessment. CONCLUSION: In a system where so many examiners are involved in neonatal hip assessment, the experience is limited for most examiners. Currently high rates of late presentation of DDH are observed locally, which are in accordance with published national experience. The potential association merits further investigation.
Assuntos
Triagem Neonatal , Humanos , Recém-Nascido , Estudos Retrospectivos , Triagem Neonatal/métodos , Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/epidemiologia , Feminino , Displasia do Desenvolvimento do Quadril/diagnóstico , Reino Unido/epidemiologia , Masculino , Exame Físico/métodos , Diagnóstico PrecoceRESUMO
All newborns are screened for developmental dysplasia of the hip (DDH), but countries have varying screening practices. The aim of this narrative mini review is to discuss the controversies of the screening and why it seems that all screening programs are likely to have same outcome. Different screening strategies are discussed alongside with other factors influencing DDH in this review. Universal ultrasound (US) has been praised as it finds more immature hips than clinical examination, but it has not been proven to reduce the rates of late-detected DDH or surgical management. Universal US screening increases initial treatment rates, while selective US and clinical screening have similar outcomes regarding late detection rates than universal US. This can be explained by the extrinsic factor affecting the development of the hip joint after birth and thus initial screening during the early weeks cannot find these cases. Conclusion: It seems that DDH screening strategies have strengths and limitations without notable differences in the most severe outcomes (late-detected cases requiring operative treatment). Thus, it is important to acknowledge that the used screening policy is a combination of values and available resources rather than a decision based on clear evidence.
Assuntos
Displasia do Desenvolvimento do Quadril , Triagem Neonatal , Ultrassonografia , Humanos , Recém-Nascido , Displasia do Desenvolvimento do Quadril/diagnóstico , Triagem Neonatal/métodos , Ultrassonografia/métodosRESUMO
PURPOSE: The incidence of developmental dysplasia of the hip (DDH) is higher in Eastern Europeans and Middle Easterners. This study aimed to establish consensus among experts in this geographical area on the management of DDH before walking age. METHODS: Fourteen experienced orthopedic surgeons agreed to participate in a four-round online consensus panel by the Delphi method. The questionnaire included 31 statements concerning the prevention, diagnosis, and treatment of DDH before walking age. RESULTS: Consensus was established for 26 (84%) of 31 statements. Hip ultrasonography is the proper diagnostic tool under six months in DDH; universal newborn hip screening between three and six weeks is necessary; positive family history, breech presentation, female gender, and postnatal swaddling are the most important risk factors; Ortolani, Barlow tests, and limitation of abduction are the most important clinical findings; Pavlik harness is the first bracing preference; some Graf type IIa hips and all Graf type IIb and worse hips need abduction bracing treatment; the uppermost age limit for closed and open reductions is 12 months and 12-24 months, respectively; anatomic reduction is essential in closed and open reductions, postoperative MRI or CT is not always indicated; anterior approach open reduction is better than medial approach open reduction; forceful reduction and extreme positioning of the hips (> 60° hip abduction) are the two significant risk factors for osteonecrosis of the femoral head. CONCLUSION: The findings of the present study may be useful for clinicians because a practical reference, based on the opinions of the multinational expert panel, but may not be applicable to all settings is provided.
Assuntos
Consenso , Técnica Delphi , Displasia do Desenvolvimento do Quadril , Humanos , Oriente Médio/epidemiologia , Feminino , Masculino , Lactente , Recém-Nascido , Displasia do Desenvolvimento do Quadril/diagnóstico , Displasia do Desenvolvimento do Quadril/terapia , Displasia do Desenvolvimento do Quadril/cirurgia , Europa Oriental/epidemiologia , Fatores de Risco , Triagem Neonatal/métodos , Inquéritos e QuestionáriosRESUMO
Introdução: A Displasia do Desenvolvimento do Quadril (DDQ) é uma doença caracterizada pela alteração anatômica durante a diferenciação embriológica do quadril ou durante o crescimento e desenvolvimento deste. O diagnóstico precoce tem grande importância na DDQ, pois logo que detectada qualquer anormalidade no quadril pediátrico, é possível uma intervenção precoce, a fim de realizar um tratamento não invasivo e de baixo custo. Ainda não existe um protocolo estabelecido de rastreio com ultrassonografia (USG) para a DDQ no Brasil. Objetivo: Implementar uma sistemática de rastreio universal para displasia do desenvolvimento dos quadris em um hospital público na cidade de São Paulo. Método: Foi realizada uma revisão da literatura a fim de justificar a importância da criação e estruturação de um Ambulatório Especializado em DDQ no Hospital do Servidor Público Municipal. Essa revisão buscou demonstrar os benefícios de um diagnóstico precoce. A partir disso, montou-se a estruturação do ambulatório. Serão acompanhados no ambulatório todos os recém-nascidos dependentes de servidores públicos municipais de São Paulo, de acordo com o protocolo estabelecido pela Instituição. Resultados: Foi proposto um modelo de atendimento envolvendo: exame físico e exames complementares, diagnóstico, tratamento conservador e/ou cirúrgico e seguimento dos pacientes. Conclusão: O atendimento do paciente portador de DDQ será centralizado. Isso inclui as etapas de diagnóstico, avaliação da evolução nos diferentes estágios do acompanhamento, tratamento com órteses específicas ou realização de cirurgias complementares. Toda a equipe multidisciplinar será composta por profissionais capacitados e treinados, em um ambiente único, o que evitará encaminhamentos. Palavras-chave: Displasia do desenvolvimento dos quadris. Ambulatório. Diagnóstico.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Recém-Nascido/crescimento & desenvolvimento , Protocolos Clínicos , Ultrassonografia , Instituições de Assistência Ambulatorial/organização & administração , Displasia do Desenvolvimento do Quadril/diagnóstico , Quadril/anormalidadesRESUMO
Importance: Universal ultrasonographic screening for developmental dysplasia of the hip (DDH) has gained increasing popularity despite the lack of benefit in terms of reducing the rates of late-detected cases (age ≥12 weeks) in randomized clinical trials. Objective: To report the reported incidence of DDH in the English scientific literature and compare rates of late-detected cases in settings with different DDH screening strategies. Data Sources: PubMed, Scopus, and Web of Science databases were searched on November 25 and 27, 2021. No time filters were used in the search. Study Selection: All observational studies reporting the incidence of early-detected or late-detected (age ≥12 weeks) DDH were included. Non-English reports were excluded if the abstract did not include enough information to be included for analysis. Data Extraction and Synthesis: The number of newborns screened and the detection rates were extracted. Meta-analysis calculated the pooled incidence of DDH per 1000 newborns with 95% CIs using a random- or fixed-effects model. This study is reported according to the PRISMA and MOOSE guidelines. Main Outcomes and Measures: The main outcome measures were early detection, early treatment, late detection, and operative treatment incidences. Results: A total of 1899 studies were identified, 203 full texts were assessed, and 76 studies with 16â¯901â¯079 infants were included in final analyses. The early detection rate was 8.4 (95% CI, 4.8-14.8) infants with DDH per 1000 newborns with clinical screening, 4.4 (95% CI, 2.4-8.0) infants with DDH per 1000 newborns with selective ultrasonographic screening, and 23.0 (95% CI, 15.7-33.4) infants with DDH per 1000 newborns with universal ultrasonographic screening. Rates for nonoperative treatment were 5.5 (95% CI, 2.1-14) treatments per 1000 newborns with clinical screening, 3.1 (95% CI, 2.0-4.8) treatments per 1000 newborns with selective ultrasonographic screening, and 9.8 (95% CI, 6.7-14.4) treatments per 1000 newborns with universal ultrasonographic screening. The incidence of late-detected DDH was 0.5 (95% CI, 0.2-1.5) infants with DDH per 1000 newborns with clinical screening, 0.6 (95% CI, 0.3-1.3) infants with DDH per 1000 newborns with selective ultrasonographic screening, and 0.2 (95% CI, 0.0-0.8) infants with DDH per 1000 newborns with universal ultrasonographic screening. The corresponding incidences of operative treatment were 0.2 (95% CI, 0.0-0.9) operations per 1000 newborns with clinical screening, 0.5 (95% CI, 0.4-0.7) operations per 1000 newborns with selective ultrasonographic screening, and 0.4 (95% CI, 0.2-0.7) operations per 1000 newborns with universal ultrasonographic screening. Conclusions and Relevance: This meta-analysis found that early detection rates and nonoperative treatments were higher with universal screening. The late detection and operative treatment rates with universal screening were similar to those among selectively and clinically screened newborns. Based on these results, universal screening may cause initial overtreatment without reducing the rates of late detection and operative treatment.
Assuntos
Displasia do Desenvolvimento do Quadril/diagnóstico , Displasia do Desenvolvimento do Quadril/epidemiologia , Triagem Neonatal/métodos , Displasia do Desenvolvimento do Quadril/diagnóstico por imagem , Displasia do Desenvolvimento do Quadril/terapia , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/epidemiologia , Luxação Congênita de Quadril/terapia , Humanos , Incidência , Lactente , Recém-Nascido , UltrassonografiaRESUMO
BACKGROUND: Newborn hip screening aims to prevent the late diagnosis of and subsequent surgical procedures for developmental dysplasia of the hip (DDH). Weather may affect how parents swaddle their babies in early life, but weather has never been formally regarded as a risk factor in hip screening. This study investigates the association between the incidence of surgically treated DDH and the outdoor temperature. METHODS: Surgical procedures for late-diagnosed DDH were investigated in 12 birth-year cohorts (1999 to 2010) using the Taiwan National Health Insurance Research Database. The number of children who underwent a DDH-related surgical procedure between 6 months and 5 years of age per total live births was evaluated as an outcome of hip screening. Trend and regression analyses were used to determine the association between the incidence of surgically treated DDH and birth year, birth month, and the temperature during the birth month and first 3 months of life. RESULTS: The mean incidence of surgically treated DDH was 0.48 per 1,000 live births (1,296 surgically treated patients per 2,712,002 live births). The incidence of surgically treated DDH among babies born in winter months (0.70 per 1,000) was significantly higher than that among babies born in summer months (0.32 per 1,000), and it was significantly correlated with mean temperature in the first 3 months of life (r2 = 0.91; p < 0.0001) and birth month (r2 = 0.68; p < 0.001). Multivariable regression revealed that external temperature in the first 3 months of life was the most significant factor (ß = -0.034 [95% confidence interval, -0.042 to -0.022]; p < 0.001) for the incidence of surgically treated DDH (adjusted r2 = 0.485). The trend of seasonal differences remained the same throughout the study years following implementation of the hip-screening policy. CONCLUSIONS: As the incidence of surgically treated DDH is the ultimate outcome of newborn hip screening, cold weather should be regarded as a risk factor and should be incorporated into future screening programs. Weather patterns of different geographical areas should be studied to determine if children born in the winter are at an increased risk for requiring a surgical procedure for DDH, and newborn hip-screening programs should be revised accordingly. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Temperatura Baixa , Displasia do Desenvolvimento do Quadril/diagnóstico , Displasia do Desenvolvimento do Quadril/cirurgia , Tempo (Meteorologia) , Bases de Dados Factuais , Diagnóstico Tardio , Displasia do Desenvolvimento do Quadril/epidemiologia , Feminino , Humanos , Incidência , Recém-Nascido , Masculino , Triagem Neonatal , Prognóstico , Fatores de Risco , Taiwan/epidemiologiaRESUMO
La displasia del desarrollo de la cadera (DDC) es una anomalía de la articulación coxofemoral caracterizada por una laxitud o posicionamiento anormal de la cabeza femoral con respecto al acetábulo. Es la patología ósea perinatal más frecuente, e incluye alteraciones que van desde el aplanamiento o la displasia acetabular hasta una luxación completa de la cabeza femoral fuera de la articulación, que puede comprometer el desarrollo y la estabilidad articular. Nuestro objetivo es transmitir una sistemática de estudio en la valoración de la cadera del recién nacido, haciendo énfasis en un examen físico correcto como pilar fundamental en la detección de la DDC, y orientar al pediatra en la selección adecuada del método diagnóstico complementario acorde a edad del paciente, con el fin de optimizar la detección y reducir el número de caderas luxadas en etapas tempranas y tardías, y así disminuir la incidencia de patologías asociadas desarrolladas a partir de este trastorno
Developmental dysplasia of the hip (DDH) is a hip joint anomaly that is characterized by a laxity or abnormal positioning of the femoral head with respect to the acetabulum. It is the most common perinatal pathology of the skeleton and includes a spectrum of alterations ranging from flattening or acetabular dysplasia, to a complete dislocation of the femoral head outside the joint that can compromise joint development and stability. The purpose of this presentation is to transmit a systematic study in the evaluation of the newborn's hip, emphasizing a correct physical examination as primordial in the detection of DDH. Also, guide the pediatriciain the proper selection of the complementary diagnostic method to be used according to the age of the patient, in order to optimize detection and reduce the number of dislocated hips in early and late stages as well as the incidence of related pathologies.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Displasia do Desenvolvimento do Quadril/diagnóstico , Exame Físico/métodos , Fatores de Risco , Diagnóstico Precoce , Displasia do Desenvolvimento do Quadril/etiologia , Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/etiologiaRESUMO
OBJECTIVE: This study aimed to determine the predictability of developmental dysplasia of the hip (DDH) in the prenatal period by means of evaluating fetal hips using the Graf method on obstetric ultrasonography (US) after the 34th week of gestation. METHODS: A total of 84 pregnant women (mean age = 27.04; age range = 19-46 years), who were referred to our radiology clinic for an obstetric US examination in the third trimester, and their fetuses were included in this study. In the obstetric US, alpha angles of both hips of the fetuses were measured based on Graf's method, and each case was assessed ultrasonographically by a second physician at 6-10 postnatal weeks. Prenatal and postnatal hips were then classified according to alpha angles as ≥ 60° or < 60°. The kappa coefficients between the diagnoses based on prenatal and postnatal alpha angles were calculated. RESULTS: According to the postnatal alpha angle, 77 fetuses were diagnosed to have type 1 right hip and 7 fetuses had type 2A right hip. The prenatal alpha angle provided the same results (77 type 1 and 7 type 2A right hips). Similarly, the postnatal alpha angle revealed type 1 left hip in 82 fetuses and type 2A left hip in 2 fetuses, which was the same as the diagnoses based on the prenatal alpha angles. There was a complete agreement between prenatal and postnatal alpha measurements for both the left and right hips (kappa = 1.00, P < 0.001). CONCLUSION: Evidence from this study has revealed that DDH can be identified by obstetric ultrasonographic examinations in the prenatal period.
Assuntos
Displasia do Desenvolvimento do Quadril/diagnóstico , Feto/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Seguimentos , Luxação Congênita de Quadril/diagnóstico , Luxação Congênita de Quadril/etiologia , Articulação do Quadril/diagnóstico por imagem , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Terceiro Trimestre da GravidezRESUMO
ABSTRACT: Ultrasonography is the ideal tool for assessing hip morphology in infants younger than 6-month-old. This study assessed the interobserver agreement and clinical disparities of the 2 most widely used ultrasound (US) methods, the Graf method, and femoral head coverage (FHC) measurement.A prospective observational study (STROBE compliant) of 2024 newborns was conducted between January 2017 and December 2018. Hip US was conducted on all newborns with abnormal Barlow and Ortolani maneuvers as well as on 50 randomly selected normal newborns. The physical examination and US were performed by a senior pediatric orthopedic surgeon with musculoskeletal sonography certification. Three observers with different levels of experience interpreted the images by using the Graf method and FHC. We analyzed the intraclass correlation coefficient, Cohen kappa, and the disparity between the clinical findings of the 2 methods.A total of 198 newborns (9.8%) presented with clinical instability, including 193 subluxatable hips in 168 patients (84.8%) and 45âdislocatable/dislocated hips in 30 patients (15.2%). The mean age at US examination was 11.69âdays (range: 0-18âdays). The intraclass correlation coefficient was .71 (95% CI: 0.55-0.83) for FHC, 0.63 (95% CI: 0.38-0.78) for the alpha angle, and 0.47 (95% CI: 0.16-0.69) for beta angle. The Cohen kappa coefficients of Graf type were 0.19 (95% CI: 0.03-0.35), 0.39 (95% CI: 0.20-0.58), and 0.17 (95% CI: 0.02-0.32) between observers 1 and 2, observers 1 and 3, and observers 2 and 3, respectively. Based on the Graf method, 14% of the stable hips had abnormal USs; by contrast, 19.2% of the subluxatable hips and 17.8% of the dislocatable/dislocated hips had normal Graf morphologies. In USs interpreted using FHC, 16% of stable hips demonstrated abnormal coverage, whereas 13.5% of subluxatable hips and 4.4% of dislocatable/dislocated hips had normal FHC.Incidence of clinically detectable hip instability was 9.8% among newborns in our series. Both alpha angle and FHC ratio revealed substantial interobserver agreement while beta angle achieved moderate agreement. FHC ratio possesses higher sensitivity and similar specificity compared with the Graf method when screening unstable hips.Level II, development of diagnostic criteria on basis of consecutive patients.
Assuntos
Antropometria/métodos , Displasia do Desenvolvimento do Quadril/diagnóstico , Triagem Neonatal/métodos , Exame Físico/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Quadril/diagnóstico por imagem , Humanos , Recém-Nascido , Instabilidade Articular/diagnóstico , Masculino , Variações Dependentes do Observador , Exame Físico/métodos , Estudos Prospectivos , Sensibilidade e Especificidade , Ultrassonografia/métodosRESUMO
La displasia del desarrollo de la cadera comprende un conjunto de anormalidades que afectan la articulación coxofemoral: la displasia, subluxación y luxación de la cadera. El concepto de "displasia" describe anormalidades en la estructura femoral, acetabular o ambas. Corresponde a la patología ortopédica más frecuente del recién nacido y lactante, lo que genera mucha preocupación e intranquilidad entre los padres, en los primeros controles sanos de sus hijos. Es una patología en la que un diagnóstico oportuno y precoz son la clave para poder realizar un tratamiento efectivo, obteniendo como resultado una cadera clínica y radiológicamente normal al finalizar el desarrollo esquelético. Para esto es fundamental conocer la patología e ir activamente en su búsqueda. Actualmente existe mucha discusión sobre la manera de pesquisar esta patología. En Chile, se realiza tamizaje universal con imagen -radiografía de pelvis- a todos los niños a los 3 meses de edad. El objetivo de la siguiente revisión, es traer a la práctica clínica actual de todos aquellos profesionales que se enfrentan en distintos escenarios a esta patología: médicos de atención primaria, enfermeras, médicos en etapas de destinación y formación en distintas regiones del país, pediatras y ortopedistas, aquellas características y signos de sospecha propios de esta enfermedad y detallar las herramientas para un correcto diagnóstico y oportuno tratamiento.
Developmental dysplasia of the hip (DDH) comprises a set of abnormalities that affect the hip joint: hip dysplasia, subluxation, and dislocation. It is the most frequent orthopedic pathology of the newborn and infant, and it generates great concern among parents during the first health check-ups of their children. It is a condition in which a timely and early diagnosis is key to be able to carry out an effective treatment, obtaining as a result of a clinically and radiologically normal hip at the end of skeletal development. For this, it is essential to know this orthopedic condition and actively search for it. Currently, there is much discussion about how to screen DDH. In Chile, universal screening with imaging - pelvic radiography - is performed on all children at 3 months of age. The objective of the following review is to bring to the current clinical practice of all those professionals who face this pathology in different scenarios: primary care physicians, nurses, physicians in training stages in different regions of the country, pediatricians and orthopedic surgeons, signs of suspicion typical of the disease and detail the assessment tools for a correct diagnosis and timely treatment.
Assuntos
Humanos , Lactente , Displasia do Desenvolvimento do Quadril/diagnóstico , Displasia do Desenvolvimento do Quadril/terapia , Fatores de Risco , Displasia do Desenvolvimento do Quadril/classificação , Displasia do Desenvolvimento do Quadril/etiologia , Displasia do Desenvolvimento do Quadril/fisiopatologiaRESUMO
OBJECTIVE: The aim of this study was to immunohistochemically identify and characterize the presence of sensory nerve endings (SNEs) in pulvinar, ligamentum teres (LT), and hip joint capsule (HJC) of children with developmental dysplasia of the hip (DDH). METHODS: Pulvinar, LT, and HJC specimens were obtained from 38 hips of 36 children (31 girls, five boys; mean age=49 months; age range=18-132 months) during open reduction surgery for DDH. All specimens underwent subsequent routine tissue processing (formalin fixation and paraffin embedding). To determine tissue morphology, haematoxylin and eosin staining was used. SNEs were analyzed immunohistochemically using a mouse monoclonal antibody against S-100 Beta Protein based on the classification of Freeman and Wyke including four types of SNEs including mechanoreceptors: type I Ruffini corpuscles, type II Pacini corpuscles, type III Golgi organs, and type IVa unmyelinated free nerve endings (FNEs). Additionally, children were sorted into three groups based on their age at the time of surgery: Group 1 (age <3 years; 19 hips of 18), Group 2 (age: 3-5 years; 10 hips of 10 children), and Group 3 (age >5 years; 9 hips of 8 children). RESULTS: Although no Type I, II, or III SNEs were identified in any specimen, type IVa mechanoreceptor (FNEs) was immunohistochemically characterized in 13 (34%) pulvinar, 19 (50%) LT, and 16 (42%) HJC specimens. The total density of FNEs was 3.31±5.70)/50 mm2 (range 0-21) in pulvinar specimens, 3.18 ± 5.92)/50 mm2 (range 0-24) in HJC specimens, and 4.51±6.61/50 mm2 (range 0-22) in LT specimens. Furthermore, the operated side, gender, and the number of FNEs in specimens did not differ significantly among the age groups (p>0.05 for all), and the number of FNEs was not significantly correlated with age, gender, or the operated side (p>0.05 for all). CONCLUSION: Evidence from this study revealed that pulvinar, LT, and HJC include only FNEs, which play a role in pain sensation, among mechanoreceptors. Surgical excision of these tissues may not cause a significant loss of sensory function in the hip joint of children with DDH. LEVEL OF EVIDENCE: Level II, Therapeutic Study.
Assuntos
Displasia do Desenvolvimento do Quadril , Articulação do Quadril , Cápsula Articular/metabolismo , Ligamentos Redondos/metabolismo , Células Receptoras Sensoriais/metabolismo , Fatores Etários , Pré-Escolar , Displasia do Desenvolvimento do Quadril/diagnóstico , Displasia do Desenvolvimento do Quadril/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Estudos ProspectivosRESUMO
OBJECTIVE: To evaluate the diagnostic performance of a deep learning algorithm for the automated detection of developmental dysplasia of the hip (DDH) on anteroposterior (AP) radiographs. MATERIALS AND METHODS: Of 2601 hip AP radiographs, 5076 cropped unilateral hip joint images were used to construct a dataset that was further divided into training (80%), validation (10%), or test sets (10%). Three radiologists were asked to label the hip images as normal or DDH. To investigate the diagnostic performance of the deep learning algorithm, we calculated the receiver operating characteristics (ROC), precision-recall curve (PRC) plots, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) and compared them with the performance of radiologists with different levels of experience. RESULTS: The area under the ROC plot generated by the deep learning algorithm and radiologists was 0.988 and 0.988-0.919, respectively. The area under the PRC plot generated by the deep learning algorithm and radiologists was 0.973 and 0.618-0.958, respectively. The sensitivity, specificity, PPV, and NPV of the proposed deep learning algorithm were 98.0, 98.1, 84.5, and 99.8%, respectively. There was no significant difference in the diagnosis of DDH by the algorithm and the radiologist with experience in pediatric radiology (p = 0.180). However, the proposed model showed higher sensitivity, specificity, and PPV, compared to the radiologist without experience in pediatric radiology (p < 0.001). CONCLUSION: The proposed deep learning algorithm provided an accurate diagnosis of DDH on hip radiographs, which was comparable to the diagnosis by an experienced radiologist.
Assuntos
Aprendizado Profundo , Displasia do Desenvolvimento do Quadril/diagnóstico , Algoritmos , Área Sob a Curva , Displasia do Desenvolvimento do Quadril/diagnóstico por imagem , Humanos , Lactente , Curva ROC , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Infant hip screening for early detection of developmental dysplasia of the hip (DDH) is essential as early detection can enable less invasive treatments and achieve better long-term results. A previous meta-analysis assessed about 10,000 infants per group, which is insufficient for evaluating the effect of different infant hip screening strategies on early detection and treatment of DDH. Therefore, we conducted a systematic review and meta-analysis using both randomized controlled trials and cohort studies to determine the effects of universal hip ultrasonography screening (UHUS) and selective hip ultrasonography screening (SHUS) on the incidence of late-diagnosed DDH. METHODS: A literature search of PubMed, EMBASE, and Cochrane databases was performed. The summary odds ratio (OR) with 95% confidence interval (CI) was calculated using fixed-effects models. RESULTS: Meta-analysis of five studies that met the eligibility criteria revealed a significant difference in late-diagnosed DDH (OR 0.44, 95% CI 0.23-0.83) between infants screened using UHUS (nâ=â29,070) and those screened using SHUS (nâ=â30,442) in a fixed-effects model without heterogeneity among studies. In the subgroup analysis, meta-analysis of the randomized controlled trials showed no significant difference in late-diagnosed DDH (OR 0.52, 95% CI 0.20-1.39) between infants screened using UHUS (nâ=â11,453) and those screened using SHUS (nâ=â12,077) in a fixed-effects model with low heterogeneity among studies (Iâ=â0.9%). However, meta-analysis of the cohort studies showed a significant difference in late-diagnosed DDH (OR 0.38, 95% CI 0.17-0.89) between infants screened using UHUS (nâ=â17,617) and those screened using SHUS (nâ=â18,345) in a fixed-effects model with low heterogeneity among studies. Sensitivity analysis revealed that the impact of each study on the summary results was not significant. There was no publication bias in our meta-analysis. CONCLUSIONS: Our meta-analysis suggests that a statistically significant decrease in the incidence of late-diagnosed DDH is possible when UHUS is adopted compared with SHUS. Our study provides information about the effects of different infant hip screening strategies on the incidence of late-diagnosed DDH, which can help decide upon which strategy to apply.
Assuntos
Displasia do Desenvolvimento do Quadril/diagnóstico por imagem , Displasia do Desenvolvimento do Quadril/diagnóstico , Humanos , Lactente , Programas de Rastreamento , UltrassonografiaRESUMO
BACKGROUND: The purpose of this study was to evaluate the efficacy of closed reduction (CR) in the treatment of developmental dysplasia of the hip (DDH) and to investigate risk factors associated with CR failure and avascular necrosis (AVN) occurrence in follow-ups. METHODS: The study retrospectively included 110 patients and 138 hips with DDH diagnosis that underwent closed reduction between February 2012 and November 2015 in our single tertiary medical institution. The failure rate of CR and the underlying risk factors were evaluated. Meanwhile, the incidence of AVN and the related risk factors among the successful CR cases were assessed. RESULTS: The overall failure rate of DDH treated by CR in the present study was 31.16% (43/138). Risk factors for the CR failure were older age at the time of CR (≥ 18.35 month), large medical interval before CR (≥ 35.35 mm), and severer dislocation of the affected hip (IDHI grades III and IV). The incidence of AVN was 8.33% (6/72) in patients with successful CR at the last follow-up. No significant risk factors had been established in the present study that associated with the AVN occurrence. CONCLUSIONS: For the treatment of DDH with CR, patients with younger age might achieve better outcomes; early diagnosis and early treatment might be the key point in the DDH treatment.
Assuntos
Displasia do Desenvolvimento do Quadril/cirurgia , Necrose da Cabeça do Fêmur/etiologia , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/etiologia , Falha de Tratamento , Fatores Etários , Pré-Escolar , Displasia do Desenvolvimento do Quadril/diagnóstico , Diagnóstico Precoce , Feminino , Necrose da Cabeça do Fêmur/epidemiologia , Seguimentos , Humanos , Incidência , Lactente , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
To develop an electronic navigation system to increase reliability and comparability in the ultrasound screening of developmental dysplasia of the hip (DDH). The impact of the navigation system on transducer positioning and on sonographic measurements according to Graf was analyzed. Twenty hips in newborns were examined sonographically using a new navigation system capable of detecting the transducer and pelvis position in order to calculate the relative tilt in the frontal, axial, and sagittal-plane. In each newborn an ultrasound image was obtained conventionally according to Graf and a second image using the sonographic navigation system. Relative roll and pitch angles and sonographic measurements were analyzed using paired T-tests and Levene-tests. Relative tilt angles in the conventional group ranged from - 8.9° to 14.3° (frontal-plane) and - 23.8° to 14.2° (axial-plane). In the navigation-assisted group ranges from - 3.0° to 3.5° and - 2.8° to 4.5° were observed. Variances were significantly lower in the navigation-assisted group (p < 0.001 and p = 0.004 respectively). The navigation system allowed for a significant reduction of relative tilt angles between the transducer and the newborn pelvis, thus supporting an optimal transducer positioning. This is a promising approach to improve reproducibility and reliability in the ultrasound screening for DDH.
Assuntos
Displasia do Desenvolvimento do Quadril/diagnóstico , Eletrônica/métodos , Luxação Congênita de Quadril/diagnóstico , Ultrassonografia/métodos , Feminino , Quadril/patologia , Humanos , Recém-Nascido , Masculino , Triagem Neonatal/métodos , Reprodutibilidade dos Testes , TransdutoresRESUMO
This consensus document has been prepared by a multidisciplinary group of experts (Paediatricians, Radiologists, Paediatric Orthopaedics) and it is mainly aimed at paediatricians, hospitals and primary care providers. We provide recommendations for the early diagnosis and treatment of Developmental Dysplasia of the Hip (DDH) and indications on its management.