Hip Ultrasound in the Neonates; The Meaning of Click Sound on Ortolani Test.

Lee,  Ki Yeol; Yun,  Eun Joo; Kim,  Yun Hwan; Chung,  Kyoo Byung; Lee,  Soon Hyuk

Journal of Korean Society of Medical Ultrasound 1997;16(3): 265-269.

Ki Yeol Lee, Eun Joo Yun, Yun Hwan Kim, Kyoo Byung Chung, Soon Hyuk Lee

¹Department of Diagnostic Radiology, Seoul University College of Medicine, Korea.
²Department of Diagnostic Radiology, Korea University College of Medicine, Korea.
³Department of Diagnostic Surgery, Korea University College of Medicine, Korea.

Published online: January 1, 2001.

ABSTRACT

PURPOSE: To find out the incidence of congenital dislocation of hip (CDH) in the neonates who have click sounds with Ortolani test, and compare between neonates who have click sounds and ones who don't in their hips using US. MATERIALS & METHODS: Targeting 1412 neonates, a pediatric orthopaedist performed Ortolani tests for click sounds, There were 100 neonates with click sounds. We performed US in 200 hip joints of the 100 neonates and measured Graf's alpha and beta angles, femur head size (FHS), head coverage percentage (HCP) of neonates who had click sounds and ones who didn't in their hips. And we made a comparison not only between click sound positive and negative hips but also between normal males and females on US using above parameters. RESULTS: Click sounds were present at right hip joint in 60 cases, at left in 34 and both hip joints in 6. Subluxation of hip joint was present in 4 neonates(4%). The comparison of mean values of measured parameters in click sounds present and not present in hip joints of males and females showed no statistical difference. Except for 4 abnormal neonates on US, the comparison of parameters between males and females in right hips, there was no statistical difference. But in left hip joints alpha angle was 63.1 +/- 3.3, 61.2 +/- 3.7, beta angle was 36.0 +/- 4.4, 39.0 +/- 5.8, FHS was 14.2 +/- 1.3, 14.0 +/- 1.2 and HCP was 63.1 +/- 4.2, 62.8 +/- 4.1 in males and females, respectively. Males had a significant higher alpha angle and lower beta angle than females (p < 0.05). CONCLUSION: The alpha angle, beta angle, femoral head size and head coverage percentage between click sounds present and not present in the hips showed no siginificant difference. But the subluxation in 4% of the neonates were present. If the click sounds are present using the Ortolani test, US may be used as a screening and valuable method in the conservative treatment planning and follow up.

Keywords: Hip. congenital dislocation; Hip. Sonography