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The positive predictive value of asymmetrical skin creases in the diagnosis of pathological developmental dysplasia of the hip.

Abstract Aims The aim of this study was to identify the association between asymmetrical skin creases of the thigh, buttock or inguinal region and pathological developmental dysplasia of the hip (DDH). Patients and Methods Between 1 January 1996 and 31 December 2016, all patients referred to our unit from primary or secondary care with risk factors for DDH were assessed in a "one stop" clinic. All had clinical and sonographic assessment by the senior author (RWP) with the results being recorded prospectively. The inclusion criteria for this study were babies and children referred with asymmetrical skin creases. Those with a neurological cause of DDH were excluded. The positive predictive value (PPV) for pathological DDH was calculated. Results A total of 105 patients met the inclusion criteria. There were 71 girls and 34 boys. Only two were found to have pathological DDH. Both also had unilateral limited abduction of the hip in flexion and a positive Galeazzi sign with apparent leg-length discrepancy. Thus, if the specialist examination of a patient with asymmetrical skin creases was normal, the PPV for DDH was 0%. Conclusion Isolated asymmetrical skin creases are an unreliable clinical sign in the diagnosis of pathological DDH. Greater emphasis should be placed on the presence of additional clinical signs to guide radiological screening in babies and children. Cite this article: Bone Joint J 2018;100-B:675-9.
PMID
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Authors

Mayor MeshTerms

Physical Examination

Keywords

Asymmetrical skin creases

DDH

Developmental dysplasia of the hip

Journal Title the bone & joint journal
Publication Year Start




PMID- 29701087
OWN - NLM
STAT- MEDLINE
DCOM- 20180516
LR  - 20180516
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 5
DP  - 2018 May 1
TI  - The positive predictive value of asymmetrical skin creases in the diagnosis of
      pathological developmental dysplasia of the hip.
PG  - 675-679
LID - 10.1302/0301-620X.100B5.BJJ-2017-0994.R2 [doi]
AB  - Aims The aim of this study was to identify the association between asymmetrical
      skin creases of the thigh, buttock or inguinal region and pathological
      developmental dysplasia of the hip (DDH). Patients and Methods Between 1 January 
      1996 and 31 December 2016, all patients referred to our unit from primary or
      secondary care with risk factors for DDH were assessed in a "one stop" clinic.
      All had clinical and sonographic assessment by the senior author (RWP) with the
      results being recorded prospectively. The inclusion criteria for this study were 
      babies and children referred with asymmetrical skin creases. Those with a
      neurological cause of DDH were excluded. The positive predictive value (PPV) for 
      pathological DDH was calculated. Results A total of 105 patients met the
      inclusion criteria. There were 71 girls and 34 boys. Only two were found to have 
      pathological DDH. Both also had unilateral limited abduction of the hip in
      flexion and a positive Galeazzi sign with apparent leg-length discrepancy. Thus, 
      if the specialist examination of a patient with asymmetrical skin creases was
      normal, the PPV for DDH was 0%. Conclusion Isolated asymmetrical skin creases are
      an unreliable clinical sign in the diagnosis of pathological DDH. Greater
      emphasis should be placed on the presence of additional clinical signs to guide
      radiological screening in babies and children. Cite this article: Bone Joint J
      2018;100-B:675-9.
FAU - Anderton, M J
AU  - Anderton MJ
AD  - Royal Adelaide Hospital, Adelaide, Australia.
FAU - Hastie, G R
AU  - Hastie GR
AD  - Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust,
      Blackburn, UK.
FAU - Paton, R W
AU  - Paton RW
AD  - Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust and
      University of Central Lancashire, Preston, UK.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Bone Joint J
JT  - The bone & joint journal
JID - 101599229
SB  - AIM
SB  - IM
MH  - Female
MH  - Hip Dislocation, Congenital/*diagnosis/diagnostic imaging
MH  - Humans
MH  - Infant, Newborn
MH  - Male
MH  - Neonatal Screening/*methods
MH  - *Physical Examination
MH  - Predictive Value of Tests
MH  - Skin
OTO - NOTNLM
OT  - Asymmetrical skin creases
OT  - DDH
OT  - Developmental dysplasia of the hip
EDAT- 2018/04/28 06:00
MHDA- 2018/05/17 06:00
CRDT- 2018/04/28 06:00
PHST- 2018/04/28 06:00 [entrez]
PHST- 2018/04/28 06:00 [pubmed]
PHST- 2018/05/17 06:00 [medline]
AID - 10.1302/0301-620X.100B5.BJJ-2017-0994.R2 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 May 1;100-B(5):675-679. doi:
      10.1302/0301-620X.100B5.BJJ-2017-0994.R2.