Screening for developmental dysplasia of the hip: results of a 7-year follow-up study.
BACKGROUND
Screening for developmental dysplasia of the hip (DDH) is widely recommended for all infants to prevent disability from late diagnosis of dislocation of the hip. The present study evaluates the results of screening for developmental dislocation of hip in a clinic in Turkey over the course of 7 years.


METHODS
Hospital records of 5798 infants who were examined regularly until walking age at Gazi University well child clinics between January 1995 and December 2001 were reviewed. Infants with known risk factors for DDH such as breech presentation, family history of DDH or swaddling, and of infants with physical examination findings suggestive of DDH, were referred to orthopedic surgeons for diagnosis. Based on this final diagnosis, sensitivity, specificity, positive and negative predictive values of risk factors and physical examination findings were calculated.


RESULTS
Of the 5798 infants, risk factors were detected in the medical history of 111 infants, and in 14 infants a musculoskeletal deformity was detected. In 606 infants the physical examination findings were suggestive of DDH. Ten patients were subsequently diagnosed with DDH. The sensitivity, specificity, positive predictive value and negative predictive values of having a risk factor for DDH in history were 10.0%, 98.1%, 0.9%, 99.8%, and having abnormal hip examination findings were 100.0%, 88.9%, 1.6% and 100.0%, respectively.


CONCLUSIONS
A careful history and physical examination is the cornerstone of DDH screening. Serial hip examinations performed during health examination visits provide an opportunity to identify DDH cases. The sensitivity of risk factors in history and physical examination findings together is high enough to be accepted as a screening tool.
Sahin
Figen
F
Department of Pediatrics, Gazi University, Faculty of Medicine, Turkey. figens2001@yahoo.com
Aktürk
Aysima
A
Beyazova
Ufuk
U
Cakir
Banu
B
Boyunaga
Oznur
O
Tezcan
Sabahat
S
Bölükbaşi
Selçuk
S
Kanatli
Ulunay
U
D001848:Bone Diseases, Developmental / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006617:Hip Dislocation / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008487:Medical History Taking; D015997:Neonatal Screening; D010808:Physical Examination; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors