The accuracy of computed tomography in assessing hip reduction in developmental dysplasia of the hip
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Date
2018
Authors
Papagapiou, Charalambos
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Abstract
Introduction: Developmental dysplasia of the hip (DDH) is a condition that
can have significant consequences on hip function in childhood and adult life
if a concentric reduction is not obtained. Confirmation of reduction through a
hip spica can be challenging especially when plain radiography relies on
indirect measurements to identify the location of an un-ossified ossific
nucleus. Imaging techniques such as computed tomography (CT) may add
value in improving detection rates following attempts at hip reduction and
maintenance of reduction.
Hypothesis: CT adds value in more accurately assessing hip reduction after
a closed or open reduction in the patient with DDH in a hip spica cast.
Study Objectives: The primary objective is to assess the accuracy of hip
reduction in a hip spica comparing X-rays and CT scans. The secondary
objective is to establish measurement parameters that may be used in both
these imaging modalities to assist in determining the adequacy of hip
reduction.
Methods: A retrospective analysis of X-rays and CT scans of 8 patients with
DDH following hip reduction and application of a hip spica cast.
Results: Eight children with nine dislocated hips were included in the study.
Five required closed reduction and four required open reduction (with one
femoral shortening). CT scans are more accurate and offer more measurable
parameters in assessing hip reduction through a hip spica.
Conclusion: Plain radiography may be misleading in confirming the presence
or absence of hip reduction and may in certain scenarios lead to unnecessary
revision surgery in cases of poor penetrance and improper anatomical
definition. Limited CT reduces paediatric pelvic organ radiation exposure and
assists in more accurately assessing hip reduction.
Description
A research report submitted to the Faculty of Health Sciences, University of
the Witwatersrand, in partial fulfillment of the requirements for the degree of
Master of Medicine.
Johannesburg, 2018.