Joseph O’Beirne’s research while affiliated with Waterford Regional Hospital and other places

Aim Aiming to offer a diagnostic tool to aid examiners with correct hip typing and decision-making about patient management, members of the Board of the International Interdisciplinary Consensus Committee on DDH Evaluation (ICODE – https://www.icode.expert), introduced the cross-platform mobile application (Android and iOS) called “ICODE Hip US Calculator”. Material and methods The examination steps of Graf’s hip sonography technique were converted into computer code and formed the basis for the development of a mobile phone application. An algorithmic approach, based on a series of conditional sentences, was followed for the development of the application (e.g. if … and … or … then). Coding of the algorithm was carried out by a Greek software development company. Results A cross-platform mobile phone application which calculates Graf’s hip type (according to the date of birth, the date of examination, and the alpha and beta angles) was constructed. The calculated hip type is then linked to simple management recommendations (discharge, rescan, refer). Conclusions “ICODE Hip US Calculator” may be used by trained health professionals to help them decide upon the hip type and the management of the baby after the scan. Hip typing is precisely calculated, and management proposals are simple and straightforward. This means that the application may be used in screening settings to help with patient management, increase the examiner’s confidence, and improve patient flow.

Since the publication of Professor Reinhard Graf’s work in 1980, Graf’s technique has become the gold standard for screening Developmental Dysplasia of the Hip (DDH) in many European and non-European countries. Despite the fact that it is supported by robust literature evidence, there is criticism about its reliability and reproducibility, questioning severalaspects of the diagnostic procedure. There is, however, concern, based on recent literature, about the quality and reliability of the published data, which may, in many cases, be based on inadequate scans, and therefore any conclusions drawn have to be questioned. The aim of this review is to demonstrate the most important aspects of Graf’s technique, to clarify the potential sources of confusion and to flag up the most common errors and mistakes made, either during the ultrasound examination, or during the reporting procedure. Furthermore, this review can be used as a guide for reviewers and editors and should help to enhance the quality control of publications on this subject.

Purpose: The aim of our study was to use the chondro-osseous border (COB) as an indispensable assessment criterion to evaluate the quality of baby hip ultrasonography (US) images in the literature pertaining to the application of Graf's technique. Materials and methods: Our literature review search yielded 144 articles. Of these, 41 contained images that were stated to be based on the application of Graf's technique. Two reviewers, a radiologist and an orthopaedic surgeon, both course instructors for the use of baby hip US for developmental dysplasia of the hip (DDH), independently evaluated the articles to assess the diagnostic validity of the published images on the basis of a single criterion: the identification of the COB. Results: Of the 41 articles which were analyzed, 15 contained images without a COB, which corresponds to 36% (roughly, one out of three). Articles from countries where universal screening is performed (Germany, Italy, Switzerland, Mongolia) were all correct. All the articles from Turkey, a country which has made significant contribution with published material about Graf's technique over many years, and most of the articles from China (80%), where Graf's technique has become popular in recent years, contained correct images. Conclusion: Published literature lacks strict criteria for the publication of correct images corresponding to Graf's technique in baby hip US. This fact raises concerns about the quality of published material (and, as a corollary, the quality of clinical application of the technique) and should have ramifications on scientific journal policies regarding the publication of such manuscripts.

Clinical examination remains a cornerstone in all branches of Medicine. In the case of DDH, even if a good ultrasound service is available, the skills of clinical examination should not be dispensed with. It is not a case of “either/or” as both ultrasound scanning and clinical examination are complementary.For those responsible for the management of babies with DDH, the various findings listed for the clinical tests in this chapter provide a valuable understanding of the pathology with which we are dealing. A good clinical examination takes only about 3 min, and while it is recognized that cases of DDH may be missed on clinical examination even in expert hands, nevertheless it is 3 min well spent.In addition, in systems that do not yet have universal ultrasound screening, clinical examination is critical. Even when universal ultrasound screening is in place, the quality of the scans, and the quality of their interpretation, can vary.For all these reasons, familiarity with the principles and practice of clinical examination is important. Such familiarity, however, needs training and practice, so training of responsible healthcare professionals in clinical examination remains a critical component of the overall effort to minimize the impact of this condition.KeywordsHipDevelopmental dysplasiaInstabilityClinical examination

Aims Developmental dysplasia of the hip (DDH) is an important cause of disability in children and young adults. Early diagnosis and treatment can help avoid more invasive interventions and long-term morbidity. This study examines the ultrasound screening programme conducted in University Hospital Waterford (UHW), and the outcomes for infants with DDH in the Southeast of Ireland. Methods We conducted an audit of all the DDH screening ultrasounds performed in UHW in the year 2020, a total of 992 infants. Data included referral and ultrasound times, screening results, interventions, and outcomes. Results Of those screened, 255 (26%) were referred to the Orthopaedic clinic, with a significant female majority of nearly 3:1. At the time of writing, only two infants were ultimately referred for further management of persistent DDH, the rest being successfully treated by less invasive interventions such as harnessing and bracing. There were no babies scanned within the recommended 6 weeks who later presented with a dislocated hip or required tertiary referral for DDH management. Conclusion The ultrasound screening programme in UHW is shown to be successful in the prompt diagnosis and early treatment of DDH. This plays a significant role in avoiding the lifelong disabling outcomes of untreated DDH, and the invasive surgical procedures required in the management of late-stage disease.

The work of Reinhard Graf exploring the use of ultrasound in the infant’s hip led to the realization that, if properly taught and practiced, ultrasound could accurately diagnose infant hip dysplasia.The first courses teaching the Graf method of infant hip ultrasound were held at Stolzalpe hospital, Murau, Austria in 1982. By 1985, courses were also being held in Germany. The first course in English was in Stolzalpe in 1987 and courses began in England in 1989 and Switzerland in 1990. They have now been organized worldwide and many thousands of participants have attended.The multidisciplinary format is one of the strengths of the courses and the ideal is when all members of a team running a service for patients with DDH attend. Not all members of the team will be performing hip sonography, but they all need to understand the technique and its role in diagnosis and management. Those who will be performing hip sonography will need further practical training leading to certification in proficiency in due course. Where practitioners have not had formal training or audit the standard of hip ultrasound is often poor.Basic courses teach the fundamentals required to be able to understand the role of, interpret, and perform hip sonograms. Refresher courses are of use to all those who have attended a basic course. They reinforce the knowledge learnt in the basic course and address any questions that have arisen.A formal curriculum was developed for the basic Graf course. Step-by-step learning using a combination of formal lectures and small group practical sessions with a course manual and homework after day 1. It has proven to be highly effective and popular.KeywordsHip sonography coursesUltrasound

The problem of Developmental Dysplasia of the Hip (DDH), a condition that was previously named as Congenital Dislocation of the Hip, has been recognized for a very long time.Clinical examination, traditionally considered as the main method for the diagnosis of the disorder, was initially supplemented with plain radiography, and then later, with ultrasound, a method suitable for the early detection of DDH.There is very encouraging evidence from countries that have established universal ultrasound screening, that this approach has impacted dramatically on the problem of DDH. However, for various reasons, we are still some distance from having worldwide agreement or uniformity on this issue. It was against this background that, in September 2018, a meeting was held in Csolyospalos, Hungary, with the aim of achieving consensus on the various topics related to the early detection and treatment of DDH.Arising from the meeting, the International Interdisciplinary Consensus Committee on DDH Evaluation (ICODE) was formalized, with an aim to work toward consensus on the various issues regarding DDH, to promote, standardize, and continually improve teaching and training in the Graf method of infant hip ultrasound and to use its international network to support research, audit, and quality improvement in the field of detection and early treatment of DDH.KeywordsInternational Interdisciplinary Consensus Committee on DDH EvaluationICODE