Screening of Dislocation of the Hip in Children. A Rigorous and Systematic Clinical Exam. A Restricted Demand for Sonography

Seance of wednesday 17 december 2014 (SÉANCE COMMUNE AVEC LA SOFCOT : CHIRURGIE ORTHOPÉDIQUE PÉDIATRIQUE)

Abstract

The advantage of congenital hip dislocation early screening is explained by the frequency of this pathology and the negative correlation between the age at diagnosis and the quality of the results. Two recent studies, conducted by the Société Française d’orthopédie pédiatrique (SOFOP), the Association Française de Pédiatrie Ambulatoire (AFPA) and the Société Française d’Imagerie pédiatrique et prénatale (SFIPP), revealed a significant alteration of the screening efficiency since 2003, characterized by an insufficient clinical approach and the lack of risk factors consideration during the first year of life. A combined process has been undertaken with the Haute Autorité de Santé (Fiche Mémo) which provides recommendations and guidelines. The screening is mainly clinical and must be repeated at each step of the child examination during the first year of life, looking for a limitation of hip abduction which is a sensible sign. Hip instability is the major sign, however its analyse requires experienced hands. Ultrasound is a complementary radiological tool, prescribed at the age of 1 month old in case of clinical anomaly or an evidenced risk factor (breech presentation, familial history of the first degree, combined orthopedic disorder induced by inadequate posture as congenital dislocation of the knee or torticolis). The advantage of systematic ultrasound, or selectively for girls, has not been evidenced. Radiography of the pelvis at 4 months old must not be applied as a screening tool. Remaining questions suggest to conduct a multicentric prospective study. Moreover, it is obligatory to involve family doctors in this project.