Magnetic resonance imaging-guided closed reduction treatment for developmental dysplasia of the hip

• Published in: Singapore medical journal Vol. 50; no. 4; pp. 407 - 411
• Main Authors: VANDEVENNE, J. E, LINCOLN, T, BUTTS PAULY, K, RINSKY, L, LANG, P. K
• Format: Journal Article
• Language: English
• Published: Singapore Singapore Medical Association 01.04.2009
• Subjects: Biological and medical sciences; Casts, Surgical; Contrast Media; Diseases of the osteoarticular system; Female; Follow-Up Studies; General aspects; Hip Dislocation, Congenital - diagnosis; Hip Dislocation, Congenital - therapy; Humans; Image Enhancement; Image Processing, Computer-Assisted - instrumentation; Infant; Magnetic Resonance Imaging - instrumentation; Male; Malformations and congenital and or hereditary diseases involving bones. Joint deformations; Manipulation, Orthopedic - instrumentation; Medical sciences; Therapy, Computer-Assisted - instrumentation; Hip joint; hipdislocation; Diseases of the osteoarticular system; Nuclear magnetic resonance imaging; Treatment; Hip dysplasia; magnetic resonance imaging-guided procedure; Malformation; imaging-guided closed reduction; closed hip joint reduction; developmentaldysplasiaofthehip; Medical imagery; Tropical medicine
• ISSN: 0037-5675

This study aimed to describe the radiological aspects and procedural steps of magnetic resonance (MR) imaging-guided closed reduction for the treatment of developmental dysplasia of the hip (DDH). Infants were positioned on a custom-made hip spica table attached to a vertically open double doughnut-shaped MR imaging unit (GE Signa SP, 0.5T) affording access to one orthopaedic surgeon and one radiologist. Standard MR imaging sequences and rapid dynamic MR imaging sequences, including fast spin-echo, fast gradient-echo and a fluoroscopic echo-planar sequence, were available. Procedural steps were described and illustrated as a guide for the radiologist actively collaborating with the orthopaedic surgeon. Five separate procedural steps were defined, describing the imaging action and the radiologist's focus related to the clinical action. These procedural steps included patient positioning, static imaging to evaluate hip congruency and factors impeding reduction, dynamic stress testing and reducing the hip while using dynamic motion MR imaging sequences to visualise reduction or dislocation, cast application with intermittent imaging confirmation of the femoral head position, and postprocedural static imaging. The role of the radiologist was well-defined during each procedural step of the MR imaging-guided closed reduction focusing on the use of specific sequences and image interpretation. Knowledge of these procedural steps may be helpful for efficient collaboration with the orthopaedic surgeon and successful MR imaging-guided treatment of DDH.