What are the generally accepted indications for a bursal injection? The main indication for bursal injection is bursitis from any…Read more
The primary indication for hip ultrasound is the detection of hip laxity or ‘clicky hips’ in infants, usually around the time of the 6 week check-up after delivery. Asymmetry of the thigh skin folds can be seen in DDH and is a further indication for referral. Hip ultrasound should also be carried out when there are risk factors; breech presentation, oligohydramnios, neuromuscular disorders or a family history of DDH in a first-degree relative.
Some countries have hip ultrasound screening programs where all children are examined with hip ultrasound soon after they are born. In Australia, the hip ultrasound study is only carried out if there are risk factors or an abnormal clinical examination.
Previous unsatisfactory examination because of femoral head ossification.
Paediatric hip ultrasound is of less value in children aged less than 6 weeks (due to immaturity of joint formation) or those aged over 6 months (where femoral ossification can prevent adequate visualisation of the acetabulum).
The variation in the normal appearance of the hip before 6 weeks-of-age significantly decreases the accuracy of the test and increases the false positive imaging incidence. However, ultrasound is appropriate for infants with signs of dislocation for whom treatment is being planned. The issue is to balance the benefit of early detection with the risk of overtreatment.
In older infants, femoral ossification, which limits visualisation of the acetabulum, is more commonly a problem in girls who tend to ossify their femoral heads at a slightly younger age than boys.
There are no adverse effects.
No post-procedural care is required. Ultrasound gel is easily cleaned off the child, who can immediately return to usual activities.
Hip ultrasound is the imaging investigation of choice. If the hip joint ossification is slightly advanced, the echogenic bone might prevent adequate examination of the hip joint, and a pelvis X-ray might be required.
Follow-up imaging and assessment might be required.
It is important that the ultrasound findings are correlated with the clinical assessment of the stability of the hip joints. The ultrasound can appear normal when the hip is clinically assessed as being unstable and requiring treatment, or the ultrasound might show an abnormality requiring treatment when the hip is clinically normal. Ultrasound studies of the hips are often repeated, if the clinical or ultrasound findings are abnormal, to ensure that normal growth/development occurs; even when no active treatment is administered.
Neonatal Handbook – Royal Women’s Hospital
Page last modified on 26/7/2017.
RANZCR® is not aware that any person intends to act or rely upon the opinions, advices or information contained in this publication or of the manner in which it might be possible to do so. It issues no invitation to any person to act or rely upon such opinions, advices or information or any of them and it accepts no responsibility for any of them.
RANZCR® intends by this statement to exclude liability for any such opinions, advices or information. The content of this publication is not intended as a substitute for medical advice. It is designed to support, not replace, the relationship that exists between a patient and his/her doctor. Some of the tests and procedures included in this publication may not be available at all radiology providers.
RANZCR® recommends that any specific questions regarding any procedure be discussed with a person's family doctor or medical specialist. Whilst every effort is made to ensure the accuracy of the information contained in this publication, RANZCR®, its Board, officers and employees assume no responsibility for its content, use, or interpretation. Each person should rely on their own inquires before making decisions that touch their own interests.