ACR Appropriateness Criteria® on Developmental Dysplasia of the Hip—Child
Boaz K. Karmazyn, MDa, Richard B. Gunderman, MD, PhDa, Brian D. Coley, MDb, Ellen R. Blatt, MDc, Dorothy Bulas, MDd, Lynn Fordham, MDe, Daniel J. Podberesky, MDf, Jeffrey Scott Prince, MDg, Charles Paidas, MDh,i, William Rodriguez, MDj,k
Developmental dysplasia of the hip (DDH) affects 1.5 of every 1,000 caucasianAmericans and less frequently affects African Americans. Developmental dysplasia of the hip comprises a spectrum of abnormalities, ranging from laxity of the joint and mild subluxation to ﬁxed dislocation. Early diagnosis of DDH usually leads to low-risk treatment with a harness. Late diagnosis of DDH in children may lead to increased surgical intervention and complications. Late diagnosis of DDH inadults can result in debilitating end-stage degenerative hip joint disease. Screening decreases the incidence of late diagnosis of DDH. Clinical evaluation for DDH should be performed periodically at each well-baby visit until the age of 12 months. There is no consensus on imaging screening for DDH. Consideration for screening with ultrasound is balanced between the beneﬁts of early detection of DDHand the increased treatment and cost factors. In addition, randomized trials evaluating primary ultrasound screening did not ﬁnd signiﬁcant decrease in late diagnosis of DDH. In the United States, hip ultrasound is selectively performed in infants with risk factors, such as family history of DDH, breech presentation, and inconclusive ﬁndings on physical examination. Ultrasound for DDH should beperformed after 2 weeks of age because laxity is common after birth and often resolves itself. A pelvic radiograph can optimally be performed after the age of 4 months, when most infants will have ossiﬁcation centers of the femoral heads. Key Words: ACR Appropriateness Criteria, pediatric, ultrasound, development dysplasia of the hip, screening, subluxation, dislocation J Am Coll Radiol2009;6:551-557. Copyright © 2009 American College of Radiology
SUMMARY OF LITERATURE REVIEW Deﬁnition
Riley Hospital for Children, Indiana University, Indianapolis, Indiana. Columbus Children’s Hospital, Columbus, Ohio. c The Children’s Hospital, Denver, Colorado. d Children’s National Medical Center, Washington, DC. e University of North Carolina, Chapel Hill, North Carolina. f Wilford Hall MedicalCenter, Lackland Air Force Base, Texas. g Primary Children’s Medical Center, Salt Lake City, Utah. h Tampa General Hospital, Tampa, Florida. i American Pediatric Surgical Association, Deerﬁeld, Illinois. j The Ofﬁce of Pediatric Therapeutics in the Ofﬁce of the Commissioner, US Food and Drug Administration, Rockville, Maryland. k American Academy of Pediatrics, Elk Grove Village, Illinois. The viewsexpressed are those of the authors and do not necessarily reﬂect or represent endorsement by the Food and Drug Administration. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria® through society representation on expert panels. Participation by representatives from collaborating societies on the expertpanel does not necessarily imply society endorsement of the ﬁnal document. Corresponding author and reprints: Boaz K. Karmazyn, MD, Riley Hospital for Children, Indiana University, 702 Barnhill Drive, Room 1053, Indianapolis, IN 46202-5200; e-mail: firstname.lastname@example.org.
Developmental dysplasia of the hip (DDH), formerly known as congenital dislocation of the hip, comprises a spectrum ofabnormalities, including abnormal acetabular shape (dysplasia) and malposition of the femoral head, ranging from dislocatable hip and mild subluxation to ﬁxed dislocation. Incidence Developmental dysplasia of the hip affects 1.5 in 1,000 of the American caucasian population; it less frequently affects African Americans. It is 4 to 8 times more common in female individuals. It is also more common in...
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