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 factors 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 (Graf 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. Breech presentation and positive family history were the two most common risk factors associated with DDH. The rate of DDH was nearly 16 times higher in the hips with at least one abnormal clinical finding than in the ones without any. Ultrasonographically unstable hips (type IIc-unstable to type IV) were always detected during clinical examination. There was a risk of missing the diagnosis of hips with acetabular dysplasia alone. Limitation of abduction and asymmetry of the skin folds were the two most common clinical findings 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 unilateral or bilateral dysplastic hip. It was concluded that a careful clinical examination was significantly more important than the coexisting risk factors in the detection of DDH.