Hip Screening in Infants Presenting with Asymmetricity of Lower Extremity

Ho Jin Jung; Woo Young Jang; Il Youp Cho; Soon-Hyuck Lee

doi:10.4055/jkoa.2017.52.3.205

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Jung, Jang, Cho, and Lee: Hip Screening in Infants Presenting with Asymmetricity of Lower Extremity

Original Article

Journal of the Korean Orthopaedic Association 2017; 52(3): 205-211.

Published online: 27 June 2017

DOI: https://doi.org/10.4055/jkoa.2017.52.3.205

Hip Screening in Infants Presenting with Asymmetricity of Lower Extremity

Ho Jin Jung, M.D., Woo Young Jang, M.D., Il Youp Cho, M.D., Soon-Hyuck Lee, M.D.

Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.

Correspondence to: Soon-Hyuck Lee, M.D. Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea. TEL: +82-2-920-5924, FAX: +82-2-924-2471, soonlee@korea.ac.kr

Received 12 April 2016 Revised 29 June 2016 Accepted 24 October 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study aimed to investigate the clinical features of congenital postural deformities and lower extremity asymmetry with respect to the presence of developmental dysplasia of the hip (DDH) in infants with a discrepancy of the limb length referred for suspected DDH.

Materials and Methods

We retrospectively reviewed the medical records and radiographs of 150 infants who visited Korea University Anam Hospital Orthopedic Clinic for suspected DDH between March 2013 and March 2015.

Results

There were greater numbers of infants with a shorter lower extremity on the left side (n=86, 57.3%) than the right. Plagiocephaly was present in 62 infants and trunk curvature in 124 infants (82.7%). Pelvic tilting—indirectly assessed by a skewed direction of the external genitalia in female infants—was present in 62 infants (63.3%). None of the 139 infants with normal physical examination of the hip were diagnosed with DDH. Of those 11 infants with abnormal findings from the hip physical examination, a total of 6 infants were diagnosed with DDH.

Conclusion

Regardless of the associated findings of congenital postural deformation, all infants diagnosed with DDH had abnormal findings from the physical examination of the hip joint. Thus, we conclude that the hip examination is important as the primary clinical screening in aiding the diagnosis of DDH.

Keywords: developmental dysplasia of hip, apparent limb-length discrepancy, pelvic obliquity, plagiocephaly, hip joint physical examination

Figures and Tables

Figure 1

(A) Right sided truncal curvature and shortened left leg is apparent in a 4-month-old boy. (B) Plagiocephaly is apparent with asymmetric flattening of the occiput either on the right or left. (C) The genital direction may indicate pelvic obliquity in girl.

Figure 2

(A) A 4-month-old girl diagnosed as developmental dysplasia of the hip (DDH) with left leg shortening. (B) Galeazzi sign showing limb-length discrepancy was present. (C) Elevated left pelvic obliquity was suspected due to genital deviation to the left. (D) Limited range of hip abduction with inguinal fold asymmetry was seen. (E) Plain radiograph revealed DDH on the left side. (F) On ultrasonography, left hip dysplasia Graf type IV was shown with an α angle of 41° and a β angle of 55°.

Table 1

Summary of the Cases with Positive Findings from the Hip Physical Examination

All patients are female infants. DDH, developmental dysplasia of hip; LLD, leg length discrepancy.

Table 2

Comparison of Characteristics between Normal Infants and Infants with Developmental Dysplasia of the Hip

Values are presented as number (%). DDH, developmental dysplasia of hip.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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