Since the first studies by Graf, medical interest for neonatal hip sonography (US) has grown, till the redefinition of the name itself of the pathologic condition, which has been recently renamed developmental dysplasia of the hip. After briefly reviewing our personal series of patients (18,388 hips studied from March, 1986, through June, 1995, with 2.81% positives according to Graf, 0.65% of them with subluxated hips), several issues are discussed relative to US of the neonatal hip in the study of dysplasia, namely: 1) technique, 2) measurements, 3) unstable hips, 4) screening, 5) protocols, 6) perspectives. Relative to the technique, Graf's method is currently the method of choice because it is easy to perform (single scanning) and repeatable, different from what other authors, particularly Novick and Harcke, suggested; they use a dynamic approach with more scans and different stress tests. Moreover, in Graf's technique, special attention is paid to the need for correct measurements, which phase was criticized by Couture who complained of its claimed complexity. Hip measurements are an important step in the study of this condition thanks to the information they yield the physician who can thus customize the therapy. The problem of the unstable hip and focal ligament laxity is discussed, which is hypothesized to be a possible cause of hip dysplasia misdiagnosis; according to Graf and Tönnis, this condition is related mostly to hormonal factors and has no actual clinical importance in the possible evolution to a pathologic condition. US of the neonatal hip must be set in a general screening program for newborns to be carried out by the 6th week of life to achieve optimal recovery in positive newborns, without limiting it to supposedly at risk groups. Moreover, the cost-benefit ratio of US screening is emphasized, provided that both medical staff and units are used correctly. A working diagnostic-therapeutic protocol is needed to plan standard epidemiologic guidelines for all physicians nationwide. Finally, we report on an initial study for new applications of US to the neonatal hip with an original computer software for automatic measurement of Wiberg's angle in the newborn, which might help predict the development of early juvenile coxarthrosis.

Hip↗

PubMedDate not supplied

Wiberg's center-edge angle in patients with slipped capital femoral epiphysis.

Wiberg's center-edge (CE) angle was measured in 104 patients with slipped capital femoral epiphysis (SCFE) to determine whether it correlates with a deeper acetabulum. Initially, the radiographs of 45 pre- and mild slip patients (group I) were measured using the contour of the femoral head to determine the head center (point C) as described by Wiberg's original article and, alternatively, using the acetabular line (Visser's method). In addition, the radiographs of 59 patients with moderate and severe slip (group II) were measured in both ways. The measurements were not statistically different between both methods and between the two groups. In 78 unilateral slips, the Mann-Whitney test did not show statistical differences between the normal side and the affected hip (p > 0.05). The Wiberg's CE angle of 58 patients was compared with that of a group control of the same age, gender, and race. The Wiberg's CE angle was significantly higher in patients with SCFE (p < 0.05), the same being true when comparing the white and nonwhite patients separately (p < 0.05 and p < 0.05, respectively). Theories involving biomechanical stress in the adolescent hip can explain the majority of slips occurring in an otherwise healthy child. The femoral head with a better coverage yields more shearing stress across the epiphyseal line. This, associated with hormonal disorders, trauma, or another deleterious factor, can progress to its failure.

Adolescent↗