The role of radiology in children hip screening in Pelhřimov Hospital, c. o.

The topic of this thesis is to compare the use of imaging methods in children hip screening and to find out the presence of developmental dysplasia of the hip (DDH) in Pelhřimov Hospital. DDH is the most common musculoskeletal developmental defect which affects approximately 5% of newborns. It includes an impaired development of acetabulum, femoral head, poor centering into the acetabulum or disproportionate extent of joint movement. DDH is being formed by interaction of genetic factors and external causes. If DDH occurs in the family, the risk neonate increases significantly. The most serious stage of this defect is hip dislocation, but we often meet a lighter form of this defect, which is called shallow acetabulum. The Czech Republic established a system of consecutive check-ups of neonates and infants. It was created on the base of Methodological Sheet of the Ministry of Health from 1996. These examinations are carried out in three stages. During these examinations, ultrasound plays a very important role. The most common method, also used in Pelhřimov Hospital, is the method of Austrian professor Graf. This method evaluates findings and classifies them into groups. After the first year of age, when ossification of structures is nearly completed, the findings cannot be evaluated by this method. X-ray examination is applied in case of diagnostic uncertainties - especially when planning subsequent treatment in children with DDH diagnosis. Imaging methods are applied to determine anatomical reposition obstacles after an unsuccessful primary reposition. We can use ultrasound, magnetic resonance, but we prefer arthrography. Arthrography is more invasive method, but unlike the others, it has got an important advantage: it can also be a therapeutic method. The theoretical part deals with anatomy, development and growth of the hip joint. I also present etiology and history of this developmental defect. The following part deals with a description of the system of clinical check-ups and diagnostics of DDH. Another part of the theoretical work is devoted to individual imaging modalities - ultrasound, X-ray, magnetic resonance and arthrography. Imaging modalities are a very specific part of radiodiagnostic. Paediatric patients are not small adults, their imaging should be restricted to a minimum and it has got its own specifics. The examination must be performed quickly and accurately, in order not to have to be repeated. Options of therapy varies according to the severity of the hip joint. A small damage of the hip joint is solved by a conservative way using various abduction tools like abduction package, Frejk duvet or Pavlík calipers. More serious cases need to be solved by hospitalization, using distraction therapy or surgery. The aim of this work was to analyze the number of paediatric patients, to find out what kind of imaging methods were indicated and performed and to compare the presence of congenital defect of the hip according to sex within Pelhřimov Hospital. The hypothesis of this thesis was formulated as follows: In paediatric hip screening examination in Pelhřimov Hospital presence of congenital defect of the hip is higher in girls than in boys. The purpose of this thesis was to create a comprehensive text dealing with the use of imaging methods in detecting developmental defects of paediatric hip. The theoretical part of this work may serve as information material for professionals and the results can be used as statistical material