The "ischial limb": a landmark on anterior ultrasound scanning used to assess reduction in developmental dysplasia of the hip

2.50
Hdl Handle:
http://hdl.handle.net/11287/593952
Title:
The "ischial limb": a landmark on anterior ultrasound scanning used to assess reduction in developmental dysplasia of the hip
Authors:
Woodacre, Timothy; Carlile, G. S.; Cox, Peter J.
Abstract:
BACKGROUND: Early recognition of failure of reduction during abduction splinting in developmental dysplasia of the hip (DDH) is essential to avoid inappropriate prolonged damaging harness use. Graf ultrasound scanning (USS) is an accepted gold standard for assessing neonatal hip dysplasia but cannot verify reduction in the abducted position of a neonatal hip in a Pavlik harness. We describe a new anatomic landmark of the hip using anterior USS-the "ischial limb," correlate this to the position of the femoral head in reduced and dislocated positions, and assess the application of this in the assessment of DDH. METHODS: A porcine model was used to identify anatomic, radiologic, and ultrasonic features comparable to the human neonatal hip. A pilot clinical study was conducted of 50 neonates (11M:39F) treated for DDH in Pavlik harness, utilizing weekly anterior USS to determine the concentricity of femoral head reduction relative to the ischial limb and whether this could identify any failures to achieve reduction. RESULTS: The animal model identified an ultrasound landmark, termed the ischial limb that represents the ossification zone of the ischial contribution to the tri-radiate acetabular cartilage, and approximates to the center of the acetabulum. Anterior USS clearly demonstrated this ischial limb in clinical practice and its relation to the femoral head in all dysplastic hips (n=79). Immediate concentric reduction was observed in 11 patients, more gradual reduction over 3 weeks in 37 patients, and failure to achieve stable reduction was verified in 2 patients. The technique was reproducible in 100% of patients (n=50). Mean additional clinic time was 5 minutes per visit. CONCLUSIONS: The ischial limb, identified on anterior hip USS, delineates the position of the tri-radiate cartilage. This technique efficiently assesses hip reduction during Pavlik harness treatment and can differentiate between failure to achieve reduction or maintain a stable reduction at an earlier stage than conventional US methods. LEVEL OF EVIDENCE: Development of diagnostic criteria on basis of consecutive patients: level 2 evidence.
Citation:
J Pediatr Orthop. 2015 Jan;35(1):62-8.
Publisher:
Wolters Kluwer
Journal:
Journal of pediatric orthopedics
Issue Date:
1-Jan-2015
URI:
http://hdl.handle.net/11287/593952
DOI:
10.1097/BPO.0000000000000185
PubMed ID:
24674894
Additional Links:
http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0271-6798&volume=35&issue=1&spage=62
Type:
Journal Article
Language:
eng
ISSN:
1539-2570
Appears in Collections:
2015 RD&E publications; General Trauma & Orthopaedics

Full metadata record

DC FieldValue Language
dc.contributor.authorWoodacre, Timothyen
dc.contributor.authorCarlile, G. S.en
dc.contributor.authorCox, Peter J.en
dc.date.accessioned2016-01-19T12:37:54Zen
dc.date.available2016-01-19T12:37:54Zen
dc.date.issued2015-01-01en
dc.identifier.citationJ Pediatr Orthop. 2015 Jan;35(1):62-8.en
dc.identifier.issn1539-2570en
dc.identifier.pmid24674894en
dc.identifier.doi10.1097/BPO.0000000000000185en
dc.identifier.urihttp://hdl.handle.net/11287/593952en
dc.description.abstractBACKGROUND: Early recognition of failure of reduction during abduction splinting in developmental dysplasia of the hip (DDH) is essential to avoid inappropriate prolonged damaging harness use. Graf ultrasound scanning (USS) is an accepted gold standard for assessing neonatal hip dysplasia but cannot verify reduction in the abducted position of a neonatal hip in a Pavlik harness. We describe a new anatomic landmark of the hip using anterior USS-the "ischial limb," correlate this to the position of the femoral head in reduced and dislocated positions, and assess the application of this in the assessment of DDH. METHODS: A porcine model was used to identify anatomic, radiologic, and ultrasonic features comparable to the human neonatal hip. A pilot clinical study was conducted of 50 neonates (11M:39F) treated for DDH in Pavlik harness, utilizing weekly anterior USS to determine the concentricity of femoral head reduction relative to the ischial limb and whether this could identify any failures to achieve reduction. RESULTS: The animal model identified an ultrasound landmark, termed the ischial limb that represents the ossification zone of the ischial contribution to the tri-radiate acetabular cartilage, and approximates to the center of the acetabulum. Anterior USS clearly demonstrated this ischial limb in clinical practice and its relation to the femoral head in all dysplastic hips (n=79). Immediate concentric reduction was observed in 11 patients, more gradual reduction over 3 weeks in 37 patients, and failure to achieve stable reduction was verified in 2 patients. The technique was reproducible in 100% of patients (n=50). Mean additional clinic time was 5 minutes per visit. CONCLUSIONS: The ischial limb, identified on anterior hip USS, delineates the position of the tri-radiate cartilage. This technique efficiently assesses hip reduction during Pavlik harness treatment and can differentiate between failure to achieve reduction or maintain a stable reduction at an earlier stage than conventional US methods. LEVEL OF EVIDENCE: Development of diagnostic criteria on basis of consecutive patients: level 2 evidence.en
dc.language.isoengen
dc.publisherWolters Kluweren
dc.relation.urlhttp://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0271-6798&volume=35&issue=1&spage=62en
dc.titleThe "ischial limb": a landmark on anterior ultrasound scanning used to assess reduction in developmental dysplasia of the hipen
dc.typeJournal Articleen
dc.identifier.journalJournal of pediatric orthopedicsen
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