A method of measuring tibial torsion with ultrasound, using reference lines on the tibia, was developed and tested on dry adult tibiae. This technique was used for evaluation of a group of children with apparently normal tibiae and another group of children with spina bifida, cerebral palsy, or clubfoot. The study showed that it is possible to measure true tibial torsion (rather than tibiofibular torsion) with ultrasound. The technique was found to be reliable and accurate enough for routine clinical use and had advantages over clinical methods and other radiographic imaging techniques. Values obtained by this technique are higher than those obtained by methods using the bimalleolar axis as the distal reference line.

Adult↗

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Dynamic ultrasound assessment for monitoring of treatment of congenital dislocation of the hip.

Of the 7,827 babies born in Sheffield between March 1989 and August 1991, a total of 114 (1.4%) who had either clinical abnormality of the hip or high-risk factors for congenital dislocation of the hip (CDH) were examined by ultrasound at birth and at regular intervals. Dynamic ultrasound assessment of both hips was done to diagnose instability and to monitor the treatment. Abnormal findings were recorded in 55 babies at the first visit, and 31 of these subsequently required treatment with the Pavlik harness (3.9 per 1,000). Only one case of late CDH has been seen among the babies who were not examined by ultrasound. There were no cases of avascular necrosis in our series. Dynamic ultrasound examination of high-risk infants' hips is a reliable method of screening for CDH. Monitoring of hips treated with the Pavlik harness, by dynamic ultrasound examination, can identify failure to obtain a concentric reduction, and in such cases, splintage can be abandoned in favour of other modes of treatment. It can, therefore, reduce the chances of overtreatment and its associated complications.

Cohort Studies↗