M Murphy D McCormack F McManus

1
RETROSPECTIVE REVIEW OF LATE PRESENTING DDH IN
THE REPUBLIC OF IRELAND 2004
M Murphy D McCormack F McManus Childrens
University Hospital, Temple Street, Dublin,
Ireland
Role of U/S Screening Ultrasound arose as a
tool for evaluation of the cartilaginous
structures of the hip in the early 1980s. Graf's
method of examination by ultrasound stresses
morphology, whereas dynamic examination uses
physical maneuvers to elicit laxity of the hip.
Universal ultrasound screening of newborns is
not deemed cost effective by most North American
authors, although in Europe selective screening
has been more widely used. Roovers EA et al
showed that u/s screening detects more children
with DDH than clinical screening. (Sensitivity
of U/S screening vs Clinical 88.5 vs
76.4) More of them are detected at an earlier
age. To accomplish this fewer children need to be
referred. However even general u/s screening
seems not to eradicate late cases of DDH.
Conclusion The incidence of late diagnosed DDH
remains high despite clinical screening. Many of
the late cases had risk factors for DDH and as
such should have been highlighted for closer
assessment and radiographs. The role of selective
ultrasound screening has been supported by
centres in Europe but has still not eradicated
all late cases of DDH. References Effectiveness
of ultrasound screening for developmental
dysplasia of the hip.Roovers EA,
Boere-Boonekamp MM, Castelein RM, Zielhuis GA,
Kerkhoff TH.Arch Dis Child Fetal Neonatal Ed.
2005 Jan90(1)F25-30.
Introduction Despite early screening, infants
continue to present late ( gt 4 months) with DDH
(Developmental Dysplasia of the Hip). The
impact of late diagnosis is significant.
Established DDH causes significant morbidity in
later life. This is reflected in procedures such
as Ganz osteotomies and THR at an early age in
DDH patients. Aims To review the
incidence of late presenting cases of DDH
nationally for a single year and assess the
patterns of referral.
Results Seventy nine cases of DDH were diagnosed
at greater than 4 months. There were an
additional 26 cases of isolated acetabular
dysplasia treated at greater than four months of
age. The mean age of diagnosis was 14.6 months
(range 4-72). Many of the late referrals had
risk factors for DDH. FM Ratio 91 ve
Family History 22 First Born Female
52 Breech 17 CTEV 3 Incidence of DDH in
2004 Total Births 2004 61517 Late DDH 2004
1.71 per 1000 births Established
Dislocation 1.28 per 1000 births
Material and Methods In a retrospective study
all cases of late presenting DDH in 2004 were
identified using inpatient database. Patient
records were retrieved and data collected. All
orthopaedic units dealing with DDH were contacted
to provide any late DDH cases treated in their
units in 2004.

Discussion The study shows that the incidence
of late diagnosed DDH remains high despite
clinical screening. Risk factors were present in
many of the late cases (especially first born
females).