CLINICAL VERSUS ULTRASONOGRAPHIC EXAMINATION IN CONGENITAL DYSPLASIA OF HIP JOINT

Background: Congenital dysplasia of hip joint (CDH) is one of the congenital anomalies in newborn that if not diagnosed and treated on time can lead to a severe instability. Although clinical examination is very useful way for screening, but in some patients a confirmatory diagnostic method such as Ultrasonography is needed. The aim of the present study is to compare the sensitivity and specificity of clinical examination and ultrasonography in early detection of CDH. Material and Methods: A total of 1000 newborn were examined by orthopedic surgeons as screening method. The newborns with risk factors or suspicious on clinical examinations were introduced to repeat clinical and ultrasonographic examination of hip joint. The results were collected and recorded by a check list and their sensitivity and specificity of clinical examination were calculated. Results: There were about 980 newborns (1,960 hips) who were studied by two methods of clinical examination and ultrasonography (by Graf Method), the overall incidence of CDH was 33 per 1000. Only 13.5% of the disordered hips according to clinical examination were involved on ultrasonographic evaluation and the remaining 72% involved hips according to ultrasonography (Graf Type IIIb or Merze) were diagnosed Normal on clinical examination. Considering ultrasonography as gold standard method of evaluating CDH, the sensitivity and specificity of clinical examination were calculated 29% and 93% respectively. Conclusion: According to present study, ultrasonographic examination has high valuable in screening of CDH and clinical examination done by experienced orthopedic surgeon has an acceptable value in primary screening of CDH in developing countries for detecting healthy neonates, but if the newborn has a risk or is suspicious on clinical examination, it will be necessary to have assistance from ultrasonography by an experienced sonographer.