P156 Paediatricians: responsible for the screening programme for developmental dysplasia of the hip (DDH)

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Abstract

Background and aims

Developmental dysplasia of the hip (DDH) is the most common deformation of the loco-motor system, caused by multiple factors, which meets the criteria to be included in national screening.The aim of this study was to present arguments why paediatricians should be responsible for the DDH screening programme, on the basis of our own twenty-years of experience in conducting non-selective, combined clinical and ultrasound DDH screening, and a critical analysis of the available literature.

Methods

At their first regular check-up by a paediatrician at the age of 5 weeks, a total of 2720 infants with 5440 hips were examined clinically and by ultrasound. The clinical examination included the Barlow and Ortolani tests.The Graf method was used for the ultrasound examination.

Results

89.4% of the infants had normal findings by ultrasound and 92.3% of the infants examined clinically. Three had a positive Ortolani test result, and one for Barlow: type II a + in 7.8%, type IIA- hips in 1.2%, type IIC in 0.9%, type IIIA in 0.5%, and type IV in 0.2% of the infants. 72% of the pathological hips shown by ultrasound were not recognised clinically. 9% of the population covered by the tests were referred to a paediatric orthopaedist for further observation. 2.8% of the population underwent conservative orthopaedic therapy, and none of the children were treated surgically.

Conclusions

Paediatricians responsible for non-selective combined clinical and ultrasound screening of the hips using the Graf method, are able to discover all forms of DDH at the age of 4 to 5 weeks, and provide orthopaedic therapy that is rational, accessible and practical for the parents and their child. Despite the sensitisation of paediatricians to the problem of early diagnosis of DDH, clinical examination as a screening method is subjective and insufficient due to its low sensitivity and the large proportion of false negative findings. Well-structured training, provided by licensed, professionally authorised educators, with the possibility of continual renewal of knowledge, is vital for optimal screening for DDH. The consistent application of diagnostic methods according to Graf, contributes to the objectivity, repeatability, feasibility and economically viability of DDH screening.

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