Orthopedics · 2026
Selective Ultrasound Screening for Developmental Dysplasia of the Hip in At-Risk Infants With Normal Physical Examinations.
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Alimi Oluwatofe, Lopez Vanessa E, Kesaria Ahad A, Camacho Alvin C, Carmichael Kelly D
Аннотация
BACKGROUND: Screening for developmental dysplasia of the hip (DDH) remains variable, particularly for infants who present with known risk factors but have normal physical examinations. This study evaluated the diagnostic yield and management impact of selective ultrasonography screening in this patient population.
MATERIALS AND METHODS: We analyzed data from all infants who underwent hip ultrasonography for at-risk screening at a single institution between 2018 and 2024. Patients with at-risk status had a normal physical examination and 1 or more DDH risk factors (ie, breech presentation, firstborn female infant, family history of DDH, or intrauterine packaging abnormality). Hips were classified using the Graf method for infant DDH. Categorical variables were compared using chi-squared or Fisher's exact testing. Unadjusted odds ratios with 95% confidence intervals were calculated to evaluate associations between specific risk factors and ultrasound outcomes.
RESULTS: Average age of the 1,010 included patients was 55 days. The cohort consisted of 53.1% female infants (n = 536) and 46.9% male infants (n = 474). Patients with dynamic instability or DDH were significantly more likely to have 2 or more risk factors compared to those without DDH (93.1% vs 60.6%; P < .001). Female sex was also strongly associated with increased odds of DDH (P < .001). Abnormal findings were identified in 21.7% of patients and directly altered clinical management in 13.4%.
CONCLUSION: These findings support the continued utility of selective ultrasound screening as part of a risk-based DDH evaluation pathway, with the highest yield observed in female infants and those with multiple risk factors.
MATERIALS AND METHODS: We analyzed data from all infants who underwent hip ultrasonography for at-risk screening at a single institution between 2018 and 2024. Patients with at-risk status had a normal physical examination and 1 or more DDH risk factors (ie, breech presentation, firstborn female infant, family history of DDH, or intrauterine packaging abnormality). Hips were classified using the Graf method for infant DDH. Categorical variables were compared using chi-squared or Fisher's exact testing. Unadjusted odds ratios with 95% confidence intervals were calculated to evaluate associations between specific risk factors and ultrasound outcomes.
RESULTS: Average age of the 1,010 included patients was 55 days. The cohort consisted of 53.1% female infants (n = 536) and 46.9% male infants (n = 474). Patients with dynamic instability or DDH were significantly more likely to have 2 or more risk factors compared to those without DDH (93.1% vs 60.6%; P < .001). Female sex was also strongly associated with increased odds of DDH (P < .001). Abnormal findings were identified in 21.7% of patients and directly altered clinical management in 13.4%.
CONCLUSION: These findings support the continued utility of selective ultrasound screening as part of a risk-based DDH evaluation pathway, with the highest yield observed in female infants and those with multiple risk factors.