Magnetic resonance imaging-guided closed reduction treatment for developmental dysplasia of the hip.
BACKGROUND
This study aimed to describe the radiological aspects and procedural steps of magnetic resonance (MR) imaging-guided closed reduction for the treatment of developmental dysplasia of the hip (DDH).


METHODS
Infants were positioned on a custom-made hip spica table attached to a vertically open double doughnut-shaped MR imaging unit (GE Signa SP, 0.5T) affording access to one orthopaedic surgeon and one radiologist. Standard MR imaging sequences and rapid dynamic MR imaging sequences, including fast spin-echo, fast gradient-echo and a fluoroscopic echo-planar sequence, were available. Procedural steps were described and illustrated as a guide for the radiologist actively collaborating with the orthopaedic surgeon.


RESULTS
Five separate procedural steps were defined, describing the imaging action and the radiologist's focus related to the clinical action. These procedural steps included patient positioning, static imaging to evaluate hip congruency and factors impeding reduction, dynamic stress testing and reducing the hip while using dynamic motion MR imaging sequences to visualise reduction or dislocation, cast application with intermittent imaging confirmation of the femoral head position, and postprocedural static imaging.


CONCLUSIONS
The role of the radiologist was well-defined during each procedural step of the MR imaging-guided closed reduction focusing on the use of specific sequences and image interpretation. Knowledge of these procedural steps may be helpful for efficient collaboration with the orthopaedic surgeon and successful MR imaging-guided treatment of DDH.
Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305, USA. vdvennej@hotmail.com
J E
JE
Vandevenne
T
T
Lincoln
K
K
Butts Pauly
L
L
Rinsky
P K
PK
Lang
D002370:Casts, Surgical; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006618:Hip Dislocation, Congenital / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008349:Manipulation, Orthopedic / Q000295:instrumentation*; D013813:Therapy, Computer-Assisted / Q000295:instrumentation*
D003287:Contrast Media