Transgluteal ultrasonography in spica cast in postreduction assessment of developmental dysplasia of the hip
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ORIGINAL PAPER
Transgluteal ultrasonography in spica cast in postreduction assessment of developmental dysplasia of the hip Mehrzad Mehdizadeh1 · Mehrshad Dehnavi2 · Aylin Tahmasebi2 · Seyed Amir Mahlisha Kazemi Shishvan3 · Nasir Babakhan Kondori2 · Razieh Shahnazari4 Received: 21 May 2019 / Accepted: 16 September 2019 © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2019
Abstract Purpose The position of the femoral head in spica cast after the reduction of developmental dysplasia of the hip (DDH) should be examined and followed up closely and regularly. The study aimed to use the transgluteal ultrasonography approach for this purpose and compare its accuracy with the results of CT scan, which is the most commonly used modality. Methods Twenty-three patients with an average age of 20–21 months were examined for 1 year after the reduction of DDH, both closed and open. Ultrasonography and CT scan were performed on the patients on the same day, and the results were interpreted by different radiologists. Transgluteal ultrasonography in spica cast was performed while the legs were abducted, internally rotated, and flexed. A blanket was placed under the patient to elevate the cast. Results Thirty cases of proper reduction (81%) and 7 cases of dislocated hip (19%) were reported in transgluteal ultrasonography, and 29 cases of proper reduction (78%) and 8 cases of dislocated hip (22%) were reported in the CT scan. The rate of agreement between the results of ultrasonography and CT scan was 91%. Conclusion Transgluteal ultrasonography can be used as an excellent modality to examine the position of the femoral head in relation to the posterior rim of the acetabulum in spica cast. The position of the femoral head can be viewed properly needless of perineal opening in the cast. Thus, transgluteal ultrasonography can replace the CT scan to assess the position of the femoral head. Sonography does not expose patients to radiation and does not require sedation. Keywords Transgluteal · Ultrasonography · Developmental dysplasia of the hip · Computed tomography · Spica cast
Introduction Developmental dysplasia of the hip (DDH) is one of the common abnormalities in newborns [1]. Its etiology is multifactorial as genetic factors, sex, race, order of birth, and hormonal and intrauterine mechanical issues influence its development [2, 3]. The incidence rate varies by the population studied, diagnostic methods, and diagnostic * Aylin Tahmasebi [email protected] 1
Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
2
Children’s Medical Center, 62 Qarib St., Keshavarz Blvd, Tehran 14194, Iran
3
Department of Orthopedics, Tehran University of Medical Sciences, Tehran, Iran
4
Department of Radiology, Iran University of Medical Sciences, Tehran, Iran
criteria. Clinical examination, ultrasonography, radiography, or a combination of these methods is used to diagnose DDH in newborns [4]. Hip instability has been reported in 11.5/1000 infants by orthopedic screening, 8
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