The role of clinical examination and risk factors in the diagnosis of developmental dysplasia of the hip: a prospective study in 188 referred young infants

In this prospective study, the role of clinical examination and risk factor s in the diagnosis of developmental dysplasia of the hip (DDH) was analysed . For this purpose, 376 hips of 188 referred infants with an average age of 3.7 months (range 0-8 months) were clinically and ultrasonographically (Gr af method) examined. Infants who had at least one risk factor for DDH had a three times higher occurence rate of DDH than those who didn't have any. B reech presentation and positive family history were the two most common ris k factors associated with DDH. The rate of DDH was nearly 16 times higher i n the hips with at least one abnormal clinical finding than in the ones wit hout any. Ultrasonographically unstable hips (type IIc-unstable to type IV) were always detected during clinical examination. There was a risk of miss ing the diagnosis of hips with acetabular dysplasia alone. Limitation of ab duction and asymmetry of the skin folds were the two most common clinical f indings associated with DDH. Nearly two-thirds of the infants with at least one positive clinical finding and at least one risk factor had either an u nilateral or bilateral dysplastic hip. It was concluded that a careful clin ical examination was significantly more important than the coexisting risk factors in the detection of DDH.