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[Ultrasound in the diagnosis and treatment of developmental dysplasia of the hip. Evaluation of a selective screening procedure].

INTRODUCTION
With the intention of reducing the treatment frequency of Developmental Dysplasia of the Hip (DDH), two hospitals in Copenhagen implemented a screening and treatment procedure based on selective referral to ultrasonography of the hip (US). This paper describes and evaluates the procedure.


MATERIALS AND METHODS
The procedure defines procedures for referral, diagnosis, treatment and follow-up of DDH. From 1998 to 2003 children with risk factors or with positive Ortolanis or Barlows test were referred to US.


RESULTS
The treatment rate was 0.47%, and the rate of late diagnosed cases 0.03%. No relationship was seen between morphological parameters at the first US and the outcome of hips classified as minor dysplastic or not fully developed (NFD). A statistically significant relationship was seen between the degree of dysplasia and the time until US normalization of the hips (p= 0.02). There was no relapse of dysplasia after treatment. The median duration of treatment was six, eight and nine weeks for mild, moderate and severe dysplasia respectively.


CONCLUSION
The procedure resulted in a low rate of treatment and a small number of late diagnosed cases. Prediction of the outcome of minor dysplastic/NFD hips must be based on a minimum of two US. An individualization of the treatment length was possible, and treatment length could be shortened in many cases. Compared with the incidence of DDH in Gentofte Hospital before the use of US, we suggest that this selective ultrasound screening procedure is worthwhile.