Special Imaging Considerations US US is performed using a high-frequency linear array transducer [38]. Two techniques have emerged: a static acetabular morphology method proposed by Graf and a dynamic stress technique proposed by Harcke [39-42]. Radiography An anteroposterior radiograph of the pelvis with the hips in neutral position allows visualization of the femoral head ossific nucleus and acetabular morphology. Proper positioning is critical as both pelvic rotation and inclination can hinder diagnostic accuracy, producing false-positive and false-negative results. Discussion of Procedures by Variant Variant 1: Child, younger than 4 weeks of age. Equivocal physical examination or risk factors for DDH. Initial imaging. For infants with equivocal physical examination or risk factors for DDH, there is evidence that the vast majority spontaneously normalize [21,55,56], and a short delay in intervention has no negative impact on outcome [22,57,58]. Therefore, the potential benefits of early diagnosis and treatment must be weighed against the risk of overtreatment and potential for iatrogenic complications [31]. Thus, the AAP recommends screening with US at the age of 4 to 6 weeks [1], and the American Academy of Orthopaedic Surgeons (AAOS) recommends pediatric orthopedic referral before 4 weeks of age [20]. US Hips Although US can be performed shortly after birth, its high sensitivity for the detection of mild acetabular immaturity and minor degrees of hip laxity can suggest pathology, potentially leading to overdiagnosis (false- positives) and overtreatment [3,5,18]. Therefore, US is not recommended during the newborn period [59]. Radiography Pelvis There is no relevant literature regarding the use of radiographs for screening of DDH in children <4 weeks of age. Variant 2: Child, between 4 weeks to 4 months of age. Equivocal physical examination or risk factors for DDH. Initial imaging.
Developmental Dysplasia of the Hip Child. Special Imaging Considerations US US is performed using a high-frequency linear array transducer [38]. Two techniques have emerged: a static acetabular morphology method proposed by Graf and a dynamic stress technique proposed by Harcke [39-42]. Radiography An anteroposterior radiograph of the pelvis with the hips in neutral position allows visualization of the femoral head ossific nucleus and acetabular morphology. Proper positioning is critical as both pelvic rotation and inclination can hinder diagnostic accuracy, producing false-positive and false-negative results. Discussion of Procedures by Variant Variant 1: Child, younger than 4 weeks of age. Equivocal physical examination or risk factors for DDH. Initial imaging. For infants with equivocal physical examination or risk factors for DDH, there is evidence that the vast majority spontaneously normalize [21,55,56], and a short delay in intervention has no negative impact on outcome [22,57,58]. Therefore, the potential benefits of early diagnosis and treatment must be weighed against the risk of overtreatment and potential for iatrogenic complications [31]. Thus, the AAP recommends screening with US at the age of 4 to 6 weeks [1], and the American Academy of Orthopaedic Surgeons (AAOS) recommends pediatric orthopedic referral before 4 weeks of age [20]. US Hips Although US can be performed shortly after birth, its high sensitivity for the detection of mild acetabular immaturity and minor degrees of hip laxity can suggest pathology, potentially leading to overdiagnosis (false- positives) and overtreatment [3,5,18]. Therefore, US is not recommended during the newborn period [59]. Radiography Pelvis There is no relevant literature regarding the use of radiographs for screening of DDH in children <4 weeks of age. Variant 2: Child, between 4 weeks to 4 months of age. Equivocal physical examination or risk factors for DDH. Initial imaging.