developmental dysplasia of the neonatal hip joint, dr trẦn ngÂn chÂu
DESCRIPTION
1,622 hip joints were enrolled and classified by TERJESEN's and GRAF's methodsTRANSCRIPT
Tran Ngan Chau, Nguyen Thien Hung, Phan Thanh Hai Medic Medical Center, HCMC, Vietnam
Background Ultrasound (US) is widely used in early detecting
developmental dysplasia of hip joint (DDH) because of its advantages
Methods of Graf (classified infant hips based on α and β angle), Terjesen (calculated the proportion of femoral head coverage (FHC)), Harcke (used dynamic US)
Objective Early detecting and following –up DDH by US, applying
2 methods: Graf and Terjesen.
Materials and methodsMaterials: 811 neonates who had high risks (family history of
DDH, breech presentations, Caesarian, club foot deformity or metatarsus adductus on clinical examination…). 1,622 hip joints were investigated.
Methods:
- A cross-sectional, descriptive, prospective study
- 7.5MHz linear transducer on each hip joint.
- Results were based on variations of dysplasia/ normal classified by and angle (Graf’s method) and ratio of femoral head coverage (Terjesen’s method)
Infants were put in a lateral decubitis position, flexed hip, coronal images of hip joints were received.
The ratio of femoral head coverage (FHC) d / D < 37 % : Dislocated
Diagnostic Criteria 1 (Terjesen’s method)
Ilium
Acetabular
(chondroid part)
Acetabular (bone part)
•α angle > 600 : Mature•500 < α angle < 600 immature•430 < α angle < 490 severe deficient/ unstable, decented •α angle < 430 : Dislocated
Diagnostic Criteria 2 (Graf’s method)
SYNOPSIS OF SONOGRAPHIC HIP TYES (GRAF’S METHOD)
Sonographic hip types (Graf and Gross description)Type α angle β angle Description
I > 600 < 550 Mature
IIa 500 - 600 550 - 770 Physiologic immature (< 12 weeks)
IIb 500 - 600 550 - 770 Delayed of immature (> 12 weeks)
IIc 430 - 490 < 770 Severe dysplasia
D 430 - 490 > 770 Unstable, decented
III <430 / not measurable >770 / not measurable Dislocated
IV Not measurable Not measurable Dislocated
http://www.turkishjournalpediatrics.org/pediatrics/images/table_TJP_426_0.jpg
3-day-old boy, his 3-year-old brother had DDHR: FHC(%) = 50% α angle = 590
L: FHC(%) = 52% α angle = 590 Conclusion: Immaturity of 2 hip joints.
1-month-old boy, breech presentationR: FHC(%) = 70% α angle = 670
L: FHC(%/) = 64% α angle = 640 Conclusion: Maturity (no dislocation) of 2 hip joints.
1- month- old boy, breech presentation.R: FHC(%) = 66% α angle = 620
L: FHC(%/) = 66% α angle = 640 Conclusion: Maturity (no dislocation) of 2 hip joints
2-day-old girl, breech presentation.X-ray: dislocation of 2 hip jointsUltrasound: R: FHC(%) = 19% α angle =280
L: FHC(%/) = 18% α angle = 290 Conclusion: Dysplasia of 2 hip joints
α αα
Results Of 1,622 joints investigated , ultrasound detected 167 joints with
dysplasia hips ( 10.29 %)
1 / - The majority of DDH was female, twice more than male
(56/811 = 6.87 % vs. 28/811 = 3.43 %).
- The proportion of dislocated left hip joint was 143/1622 = 8.81% , nearly 3 times more than right ones (48/1622 = 2.95 % ) .
- The rate of femoral head coverage < 37 % = 161/1622 (9.92 % ) .
- The rate of α angle < 430 = 91/1622 (5.61%)
- The rate of α angle < 430 and FHC< 37 % = 60/1622 (3.69% )
2/ Classification:
1,622 hip joints was distributed according to the standard of Graf’s classification and extended modified by Schulz
Type Ia : Maturity
Type IIa:Immaturity
Type IIc : Minor dysplasia
(severe deficient)
Type IV : Major dysplasia
(dislocated)
Number of hip joints
Rate Number of hip joints
Rate Number of hip joints
Rate Number of hip joints
Rate
240 14.80% 986 60.79% 229 14.12% 167 10.29%
241 cases follow-up visit after physiotherapy
After 2 months: 158 cases
3 months: 48 cases
6 months: 35 cases Persistent DDH cases after physiotherapy
Until 30 days: 21 cases
45 days: 5 cases
60 days: 9 cases
180 days: 3 cases
3/Follow-up Visit Cases
Discussions
US can detect DDH during the first week of age.There is no “gold standard” of US for diagnosing DDH,
especially in the 3 first months of age.Our results show higher ratio of DDH according to Terjesen
(9.92%) than to Graf (5.61%).2 methods Terjesen and Graf should be used together to find
out and classify DDH in an examination.Terjesen’s method seemed to be simple to apply in routine.Some other studies also show higher ratio of DDH in applying
Terjesen’s method
Conclusions Our results show higher ratio of DDH according to
Terjesen (9.92%) than to Graf (5.61%). Terjesen’s method is simple to apply for detecting
DDH while Graf’s method is helpful for classification and treatment strategy setting up.
Ultrasound played an important role in detecting DDH in the first 3 months of age because of its advantages.
Thanks for your attention!