Why take your child for a hip ultrasound?
A child's first encounter with an orthopaedic specialist is usually when a hip ultrasound is performed. Hip ultrasound and a clinical examination of the infant (a child aged from 4 weeks to one year) are primarily used to detect and treat, in time, the most common musculoskeletal conditions of infancy, such as developmental hip dysplasia, torticollis and foot deformities. Although the great majority of children are born healthy and without musculoskeletal problems, a timely hip ultrasound and examination by a paediatric orthopaedic specialist is advisable, because any problems found can be treated faster, more successfully and more simply the sooner therapy begins.
When should a child have a hip ultrasound?
For children born at term, from the 39th week of pregnancy onward, it is best to perform a hip ultrasound at 5–8 weeks of age. However, for children with a family history of treatment with Pavlik harness as an infant, a limp in youth, or similar, as well as children born in the breech position (regardless of whether delivery was vaginal or by caesarean section), it is advisable to perform the hip ultrasound somewhat earlier. A positive family history, breech position in the womb, and reduced amniotic fluid during pregnancy (oligohydramnios) are risk factors for developmental hip dysplasia. However, developmental hip dysplasia – sometimes referred to as hip dislocation – is a genetic condition that is not caused by the act of birth itself but is already present in the fetus in the womb. The statement “his hips were dislocated during birth because he was breech” is therefore not considered accurate.
How is a hip ultrasound performed?
In Croatia, the accepted method for hip ultrasound is the Graf method, in which the infant is placed on their side and the ultrasound probe is placed against the upper part of the hip being examined. It should be noted that hip ultrasound is a subjective imaging method, and obtaining a technically correct finding and interpreting it correctly requires knowledge and skill gained through clinical experience.
What can a hip ultrasound reveal?
Infant hip ultrasound is the so-called gold standard for detecting developmental hip dysplasia. To be dysplastic means to be abnormally developed. In the case of developmental hip dysplasia, this means that the hip socket in the pelvis is too shallow, so the head of the femur does not sit correctly in place and the hip joint does not develop as it should. Essentially, with infant hip ultrasound we want to see whether the hip is properly developed or, as the case may be, too shallow. If hip dysplasia is found on ultrasound, treatment should begin as soon as possible. Dysplasia does not have to be present in both hips – it is usually on the left side and in female infants.
What happens if developmental hip dysplasia is found?
Since developmental hip dysplasia has various clinical presentations and degrees of severity, treatment must be tailored to the severity of the dysplasia and the age of the child. Detected in time, dysplasia is usually treated conservatively with a Pavlik harness, and if the child is younger and less mature, abduction pants may also be tried. If dislocation is present alongside the dysplasia, a Hilgenreiner splint or casting may sometimes be needed. All of these methods share the same idea: positioning the head of the femur over the dysplastic – too shallow – socket so that, in that position, mechanical pressure gradually deepens the socket. This is possible while children are young and the hip socket is still cartilaginous and can be reshaped. Unfortunately, developmental hip dysplasia is sometimes not detected in time, and the potential for reshaping is then small, meaning surgical treatment must be undertaken straight away. The purpose of all treatments for developmental hip dysplasia is to establish as normal a relationship as possible within the hip joint and, later, optimal joint function – that is, pain-free movement through a full range of motion. Untreated hip dysplasia leads to abnormal wear of the hip joint cartilage, pain, limping and the development of secondary osteoarthritis, which ultimately has to be treated with a hip replacement – an artificial hip joint.
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