ULTRASOUND IN THE DIAGNOSIS OF THE IRRITABLE HIP IN CHILDREN

Hip pain during infancy is frequently harmless by nature and hardly de mands any therapeutic intervention. A careful differential diagnosis i s of great importance. Aim: In our study we attempted to evaluate the significance of sonography as a non-radiant and economical aid in the differential diagnosis of hip diseases during infancy. Methods: The st udy population consisted of children aged from 2 to 14 years, who visi ted our clinic with hip complaints and evident capsular distension (mo re than 2 mm compared to the contralateral hip joint) and without prec eeding diagnosis. The study period was from 1988 to 1995. From the 82 children enrolled in this study we diagnosed Coxitis fugax (n = 54), M orbus Perthes (n = 19), Epiphysiolysis capitis femoris (n = 5), rheuma tic arthritis (n = 2), septic Arthritis (n = 1) and femoral Osteoid-Os teoma (n = 1). All patients with Coxitis fugax were scheduled for clin ical and sonographic re-examination. Results: Coxitis fugax is the mos t frequent disease of the hip during infancy. Perthes desease is the m ost important differential diagnosis up to the age of 10 years. Epiphy siolysis capitis femoris and rheumatic diseases proved to be most comm on differential diagnosis among elderly children. As a result of our s tudy we were able to establish a diagnostic algorithm of hip diseases during infancy. Sonographic examination proves to be of great value es pecially in the differential diagnosis of Coxitis fugax and M. Perthes . In many cases the X-ray examinations which were previously mandatory could even be dispensed with. Relevance: although this concept requir es careful supervision of the patients, it spares 60% of the children from undergoing X-ray examinations or MRI.