Inter-Gender Pelvic Shape Variations as a Cause of DDH Overdiagnosis

Therapeutics and Clinical Risk Management
Khalid M AbdallaKhaled Obeidat

Abstract

Developmental dysplasia of the hip (DDH) is an abnormal relationship between the acetabulum and the head of the femur. Plain x-ray of both hips at the age of 3 months is still in use in some countries. On plain films, classic lines and angles are evaluated to meet current guidelines for positive DDH. Among these is the acetabular angle (AA), which most did not exceed 30° in normal pelvis regardless of gender. A flat promontory gives the impression of a high AA angle, whereas a sharp promontory gives the impression of a low AA angle. All anteroposterior (AP) pelvic digital x-ray studies performed to rule out DDH were collected from the PACS systems. A novel angle was measured between a line parallel to the lateral aspect of the region of the inferior iliac spines and a line that extends along the acetabular roof to quantify the roundness of the iliac promontory. We called the former line the Miral line and the formed angle the iliac promontory angle. We show that the promontory shape is significantly different between genders, and therefore it is mistaken to generalize an upper AA limit for males and females. In addition, we show that the current guideline of the upper limit of AA did not predict the incidence of DDH. We suggest...Continue Reading

References

Aug 3, 2011·Orthopedic Reviews·Shahryar NoordinHaq Nawaz
Feb 11, 2014·Journal of Children's Orthopaedics·Hakan Omeroğlu
Dec 31, 2015·World Journal of Orthopedics·Pavel KotlarskyMark Eidelman
Sep 20, 2017·Acta ortopedica brasileira·Bruno Gonçalves Schröder E SouzaValdeci Manoel de Oliveira
Dec 28, 2018·Pediatrics·Scott YangRachel Y Goldstein
Feb 15, 2019·European Journal of Orthopaedic Surgery & Traumatology : Orthopédie Traumatologie·Libor NecasBoris Steno

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