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A Review of “Capture rate’’ Between Physicians and Care-giver Suspicion Leading to Diagnoses of Late-presenting DDH: A Single Centre perspective

Volume 6 | Issue 2 | May-August 2020 | Page: 7-11 | Atul Bhaskar, Purva Kansara Authors : Atul Bhaskar [1][2], Purva Kansara [1] [1] Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India. [2] Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India. Address of Correspondence Dr. Atul […]

Beware The Negative Ultrasound: Two Cases Of Septic Arthritis Without Ultrasonographic Findings

Volume 6 | Issue 2 | May-August 2020 | Page: 4-6 | India Cox, Fergal Monsell Authors : India Cox [1], Fergal Monsell [2] [1] Department of Orthopaedics, Musgrove Park Hospital, Taunton, UK. [2] Department of Orthopaedics, Bristol Royal Hospital for Children, Bristol, UK. Address of Correspondence Dr. India Cox, Clinical Fellow Trauma and Orthopaedics, […]

A Review of “Capture rate’’ Between Physicians and Care-giver Suspicion Leading to Diagnoses of Late-presenting DDH: A Single Centre perspective

Beware The Negative Ultrasound: Two Cases Of Septic Arthritis Without Ultrasonographic Findings

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A Review of “Capture rate’’ Between Physicians and Care-giver Suspicion Leading to Diagnoses of Late-presenting DDH: A Single Centre perspective

Volume 6 | Issue 2 | May-August 2020 | Page: 7-11 | Atul Bhaskar, Purva Kansara

Authors : Atul Bhaskar [1][2], Purva Kansara [1]

[1] Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Atul Bhaskar,
Hon.Paediatric Orthopaedic Surgeon, Bombay Hospital Institute of Medical Sciences, Mumbai,
Maharashtra, India.
E-mail: arb_25@yahoo.com

Abstract

Background: The manifestations of DDH (Developmental Dysplasia of Hip) from newborn to walking age can go undetected due to several factors in the developing world. Lack of screening, reduced awareness amongst primary care physicians, socio-economic factors of family and access to healthcare facility. In many children the initial diagnosis is established only after an alert caregiver of physician notices suspicious asymmetry in gait pattern or limp.
The purpose of this review to compare the “capture’’ rate between physicians and caregivers suspicion that lead to the initial diagnosis of DDH and suggest strategies to enhance early detection of DDH.
Patient and Methods: A retrospective observational study was conducted between January 2002 and December 2018 at a single surgeon specialty centre in Mumbai, India. All children with a diagnosis of idiopathic DDH were included. Syndromic and teratologic hips were excluded. The data recorded from the charts included the following: birth history, mode and presentation of delivery, breech or normal, first born or later, age at initial presentation, demographic data, and whether hailing from urban or semi-urban and rural areas, and initial awareness by physician or caregiver. Any associated anomalies, and the side of involvement and surgical intervention was also recorded.
Results: The median age of diagnosis of DDH in the study was 22 months (one week-10 years) but in bilateral DDH it was 32 months (p<.0001). Physicians diagnosed DDH primarily in 37 children (28%) and 95 children (70.45%) were brought to the attention by caregivers especially in semi-urban and rural areas (p<0.001). Eighty-five children (64.39%) were diagnosed in the walking ages between 12 months – 48 months. Ninety-eight children (74.24%) in the entire study required surgical intervention mainly due to the late diagnosis made after infancy.
Conclusion: Delay in diagnosis of idiopathic DDH has significant implications both for surgeons, caregivers, and health care service providers. Any suspicious gait or limp in a child at walking age should alert investigation to rule out DDH.
Keywords: DDH; CAREGIVER; LIMP.

References

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How to Cite this Article: Bhaskar A | A Review of “capture rate’’ Between Physicians and Care-giver Suspicion Leading to Diagnoses of Late-presenting DDH: A Single Centre perspective | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 07-11.

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Beware The Negative Ultrasound: Two Cases Of Septic Arthritis Without Ultrasonographic Findings

Volume 6 | Issue 2 | May-August 2020 | Page: 4-6 | India Cox, Fergal Monsell

Authors : India Cox [1], Fergal Monsell [2]

[1] Department of Orthopaedics, Musgrove Park Hospital, Taunton, UK.

[2] Department of Orthopaedics, Bristol Royal Hospital for Children, Bristol, UK.

Address of Correspondence
Dr. India Cox,
Clinical Fellow Trauma and Orthopaedics, Musgrove
Park Hospital, Taunton, UK.
E-mail: india.cox@gmail.com

Abstract

Septic arthritis is a clinical diagnosis but ultrasound has long been used as an adjunct, with a lack of effusion on ultrasound examination being viewed as a reassuring sign. This report describes two cases of children with clinical features suggestive of septic arthritis in whom initial ultrasound failed to demonstrate a joint effusion but subsequent arthrotomy confirmed septic arthritis. We discuss some potential reasons behind this and caution that wherever clinical suspicion exists, a negative ultrasound should not be viewed as ruling out septic arthritis.
Keywords: Septic arthritis; Ultrasound, joint effusion.

References

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4. Jacobson JA, Andresen R, Jaovisidha S, De Maeseneer M, Foldes K, Trudell DR, Resnick D. Detection of ankle effusions: comparison study in cadavers using radiography, sonography, and MR imaging. American Journal Roentgenology 1997;170(5):1231-8
5. Gordon JE, Huang M, Dobbs M, Luhmann SJ, Szymanski DA, Schoenecker PL. Causes of false-negative ultrasound scans in the diagnosis of septic arthritis of the hip in children. Journal of Pediatric Orthopedics 2002;22:312-16.

How to Cite this Article: Cox I, Monsell F | Beware The Negative Ultrasound: Two Cases Of Septic Arthritis Without Ultrasonographic Findings | International Journal of Paediatric Orthopaedics | May-August 2020; 6(2): 04-06.

Half Sized Blog Element (Single Author Style)

Half Sized Blog Element (Multi Author Style)

A Review of “Capture rate’’ Between Physicians and Care-giver Suspicion Leading to Diagnoses of Late-presenting DDH: A Single Centre perspective

Beware The Negative Ultrasound: Two Cases Of Septic Arthritis Without Ultrasonographic Findings

A Review of “Capture rate’’ Between Physicians and Care-giver Suspicion Leading to Diagnoses of Late-presenting DDH: A Single Centre perspective

Beware The Negative Ultrasound: Two Cases Of Septic Arthritis Without Ultrasonographic Findings

Full Sized Blog Element (Big Preview Pic)

A Review of “Capture rate’’ Between Physicians and Care-giver Suspicion Leading to Diagnoses of Late-presenting DDH: A Single Centre perspective

Authors : Atul Bhaskar [1][2], Purva Kansara [1]

Abstract

References

(Abstract) (Full Text HTML) (Download PDF)

Beware The Negative Ultrasound: Two Cases Of Septic Arthritis Without Ultrasonographic Findings

Authors : India Cox [1], Fergal Monsell [2]

Abstract

References

(Abstract) (Full Text HTML) (Download PDF)

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