Document Detail


MR-based parameters as a supplement to radiographs in managing developmental hip dysplasia.
MedLine Citation:
PMID:  21909467     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Some dysplastic hips with favorable radiographic parameters fail to develop normally, suggesting that we should consider cartilaginous or soft tissue structures for further information regarding the condition of the hip. The purpose of this study was to provide a clear definition of concentric reduction in developmental dysplasia of the hip (DDH) based on magnetic resonance imaging (MRI), and to determine how radiographic and MR-based parameters could be used together to treat dysplastic hips.
METHODS: We studied range of motion (ROM)-MRI of 25 patients with unilateral hip dysplasia (mean age at the time of MR imaging, 44.1 months). Each ROM-MRI consisted of a set of bilateral hip scans in the following positions: neutral; abduction; abduction- internal rotation; abduction-internal rotation-flexion; and adduction. Before MR scanning, the 25 patients received the following primary treatments: closed reduction (n = 15; at a mean age of 14.5 months); and open reduction (n = 10; at a mean age of 10.0 months). The following new parameters appear to be useful in treating DDH: 1) the labral angle, the angle the labrum makes with the acetabulum; 2) the uncorrected labral deformity (ULD), the "residual deformity" (deflection of the labrum) when the affected labrum is freed from pressure in abduction; and 3) the zone of compressive force (ZCF), the region of the acetabulum through which the body weight acts on the femoral head.
RESULTS: A concentrically-reduced hip is one in which the labrum points downward in the neutral position, at the same angle as that of the normal side; and in which the ZCF is zone 3, the inner acetabular zone as defined herein. The ULD and the ZCF may be determined precisely as we have done, or the physician may simply observe the changes in the orientation of the labrum and compare the changes qualitatively to the unaffected side, and likewise for the medial joint space.
CONCLUSIONS: Detailed analysis of the labrum as permitted by ROM-MRI, together with acetabular index and other parameters measured from radiographs, provides important information for physicians treating childhood hip dysplasia.
Authors:
Hui-Taek Kim; In-Bo Kim; Jong-Seo Lee
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Publication Detail:
Type:  Journal Article     Date:  2011-08-19
Journal Detail:
Title:  Clinics in orthopedic surgery     Volume:  3     ISSN:  2005-4408     ISO Abbreviation:  Clin Orthop Surg     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-12     Completed Date:  2012-01-12     Revised Date:  2012-04-26    
Medline Journal Info:
Nlm Unique ID:  101505087     Medline TA:  Clin Orthop Surg     Country:  Korea (South)    
Other Details:
Languages:  eng     Pagination:  202-10     Citation Subset:  IM    
Affiliation:
Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University Hospital, Seo-gu, Busan, Korea. kimht@pusan.ac.kr
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MeSH Terms
Descriptor/Qualifier:
Child, Preschool
Female
Hip Dislocation, Congenital / diagnosis*,  physiopathology,  radiography,  surgery
Hip Joint / pathology,  physiopathology,  radiography
Humans
Infant
Magnetic Resonance Imaging*
Male
Range of Motion, Articular
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