Reliability of the computed tomography criteria after closed reduction of developmental dislocation of the hip

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Abstract

BACKGROUND: Developmental dislocation of the hip includes femoral head subluxation or dislocation and/or acetabular dysplasia. Closed reduction of the hip should be performed under general anesthesia. Appropriate performance and interpretation of closed reduction are difficult and require experience. The role of computed tomography (CT) in different aspects of treatment of developmental hip dysplasia is well established. It was an accurate way to assess the adequacy of reduction of dislocated hips for patients in spica casts.

AIM: This study aimed to assess the role of CT in the evaluation of closed reduction of developmental hip dislocation in infants and children immobilized in spica casts.

MATERIALS AND METHODS: This study included 16 patients with 20 involved hips who presented with developmental hip dysplasia. The youngest patient was 12 months old, and the oldest was 24 months old, with a mean age of 19.62 ± 4.27 months. There were 15 girls (93.75%) and one boy (6.25%). There were four patients with bilateral hip involvement (25%), and the right side was involved in five hips (31.25%), whereas the left side was affected in 7 (43.75%) hips.

RESULTS: Closed reduction was performed in 20 hips, and according to the post-reduction CT evaluation, the final results were satisfactory in 16 (80%) hips and unsatisfactory in 4 (20%) hips. On the coronal CT cuts, the modified Shenton’s line gave a sensitivity of 75%, specificity of 81.25%, and accuracy of 80%. Second, the calculation of femoral head coverage on coronal CT cuts showed the highest sensitivity of 100%, specificity of 50%, and accuracy of 60%. Lastly, the posterior neck line identified on the axial CT cuts gave a sensitivity of 75%, specificity of 87%, and accuracy of 85%. On comparing and evaluating the three methods, the method that gave the best level of reliability for the adequacy of the reduction was the posterior neckline (82.23 %), followed by modified Shenton’s line (78.75%), and finally femoral head coverage (70%).

CONCLUSIONS: The posterior neck line is the preferred method to confirm the adequacy of hip relocation on multi-slice post-reduction axial CT.

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About the authors

Lofty El-Adwar Khaled

Alexandria University

Email: khaled_eladwar@yahoo.com
ORCID iD: 0000-0001-7249-321X

MD, Professor, senior surgeon

Egypt, Alexandria

Taha Kotob Hesham

Alexandria University

Email: htkotob@yahoo.com
ORCID iD: 0000-0002-2710-610X

MD, Professor, senior radiologist

Egypt, Alexandria

Abdel Razek Amin

Alexandria University

Author for correspondence.
Email: aminrazek@yahoo.com
ORCID iD: 0000-0002-3210-3835
Scopus Author ID: 36772814200

MD, Professor

Egypt, Alexandria

Abdelkareem Mohamed

Alexandria University

Email: m.elzoka@yahoo.com
ORCID iD: 0000-0003-1130-4133

MS, specialist of orthopedic surgery

Egypt, Alexandria

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Supplementary files

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2. Fig. 1. Continuous right sided modified Shenton’s line (a); interrupted left sided modified Shenton’s line (b)

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3. Fig. 2. Posterior neck line. Post reduction single slice CT showing the posterior neck line in a reduced left hip (a). Post reduction single slice CT image with the posterior neck line revealing a dislocated left hip (b)

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4. Fig. 3. Degree of Femoral head acetabular coverage. A base line was drawn tangential to the outer os ilium of the acetabulum (line A) parallel to the iliac bone. Another line was drawn parallel to the former and passing tangential to the visualized medial aspect of the cartilaginous femoral head noted by the pulvinar (line B). A third line was drawn parallel to the other two lines and passing tangential to the visualized lateral aspect of cartilaginous femoral head (line C). The distance between the medial (B) and iliac lines (A) is represented by d, and the distance between the medial (B) and lateral lines (C) by D. The ratio of d to D multiplied by 100 indicates the percentage of the femoral head covered by the bony acetabulum. A percentage more than 60% was considered a successful reduction

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5. Fig. 4. Twenty two-month old female patient presented with a Trendelenburg gait, limited left hip abduction and shortening of the left lower limb. Plain radiographs showed a right DDH (a). Post closed reduction (adductor tenotomy and closed reduction) radiographs showed an intact Shenton line (b). Post closed CT showed dislocated femoral head with intact modified Shenton’s line (c), posteriorly displaced posterior neck line (d) and femoral head coverage of 36% (e). This patient with intact modified Shenton’s line, posteriorly displaced posterior neck line and femoral head coverage of 36% has not continued closed reduction and underwent open reduction

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Copyright (c) 2022 Khaled L.E., Hesham T.K., Amin A.R., Mohamed A.

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