63 Beyond the clinical exam: Assessing the added value of imaging in breech newborns for hip dysplasia screening
Notice bibliographique
Résumé
Abstract Background Developmental dysplasia of the hip (DDH) is the most prevalent neonatal musculoskeletal disorder, affecting 1-4% of all newborns. It can lead to delayed motor development and osteoarthritis, often requiring surgical intervention. A known risk factor for DDH is breech position during gestation; however, up to 50% of infants diagnosed may have normal hips at birth, as hip develops in the initial months of life. The effectiveness of screening methods, especially radiological imaging, remains debated. In 2014, the American Academy of Orthopaedic Surgeons (AAOS) recommended imaging for this at-risk group before 6 months of age. Objectives The study aimed to assess the additional screening value of imaging for detecting DDH in breech newborns compared to clinical examination alone. Design/Methods This retrospective observational study included all infants in breech position during the third trimester born at our tertiary academic center between June 2021 and December 2022. Infants were included if they underwent hip ultrasound at 6 weeks at our center and were prescribed hip radiography at 6 months. Data were collected from medical records, including demographic informations, physical examination findings, imaging results, and treatment details. This study was approved by the local ethics committee. Results A total of 518 patients were included in the study, categorized as follows: breech (n=374), transverse (n=13), and cephalic with a history of third-trimester breech positioning (n=131). Among these, 405 (78%) were term births, and 113 (22%) were preterm (Table 1). Hip radiography was conducted for 394 patients. Screening lead to the identification of 47 cases of suspected DDH: 9 (19.1%) detected through physical examination at birth, 23 (48.9%) by ultrasound at 6 weeks, and 15 (31.9%) via radiography at 6 months. Of the 47 patients referred to paediatric orthopedics, 17 underwent harness treatment: 6 due to abnormal physical examination findings, 8 based on ultrasound results, and 3 from radiographic findings. This resulted in an overall DDH prevalence of 7.3% diagnosed through imaging methods. The number needed to screen (NNS) was 86 for physical examination, 65 for ultrasound, and 131 for radiography. Conclusion Our findings indicate that while physical examination at birth can identify some cases of DDH, supplemental imaging, particularly a 6-week ultrasound, enhances early detection in breech-presenting infants. Given the high number needed to screen with routine 6-month radiography, its standard use may warrant re-evaluation. These results underscore the value of targeted imaging for at-risk populations to optimize timely diagnosis and intervention for DDH.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,015 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».