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The role of radiology in children hip screening in Pelhřimov Hospital, c. o.
CHADIMOVÁ, Jana
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.
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The possibilities of physiotherapy treating children with evolutionary hip joints disorders
PEŠTUKOVÁ, Lucie
This bachelor thesis deals with the possibilities of physiotherapy treating children with evolutionary hip joint disorders. The theoretical part describes general background related to the issue. The content of the theoretical part brings a summary of findings related to the anatomic-physiologic relation of the hip joint, describes diagnostics and treatment of children affected by hip dysplasia and summarizes knowledge based on motor development of a child in relation to hip joints. Development Dysplasia of the Hip (DDH) belongs to the most frequent disorders of infant locomotor system and brings numerous morphological deviations that might include simple instability, subluxated or luxated femoral head or other serious pathologies. Therapy choice is then different, depending on the character of diagnosed deformities, and influences individual growth during development. Numerous factors contribute to DDH occurrence, originally the genetic factor used to be considered the main factor, new researches however mention influence of mechanic factors in prenatal live (e.g. foetus position during birth) as well as in postnatal live (e.g. forced deflection of legs immediately after birth or tight wrapping of an infant in swaddling clothes) and of higher hip capsular laxity. DDH treatment has undergone lots of changes during development. The Czech Republic is one of few states paying special attention to early detection and therapy. Research into the issue is linked to great figures like Zahradníček, Frejka, Pavlík and many more. Screening tests already start at maternity wards and continue to the following weeks of life in our conditions. Deviations are detected through clinical examinations performed by a paediatric orthopaedist and are based on images taken by various imaging methods. Therapy possibilities differ according to the joint damage character. Less serious hip joint deformities are treated by conservative methods including treatment with abduction aids including e.g. Frejka Pillow, Pavlík Stirrups and others. Surgery interventions and hospitalization have to be applied to more serious cases. DDH treatment is relatively successful nowadays and starts immediately after pathology detection. Nevertheless there are mixed opinions on treatment requirements among specialists. A lot of orthopaedists are satisfied with conservative treatment immediately after detection. Influence of this kind of therapy has its justification and its irreplaceable importance backed by numerous studies. Today?s physiotherapy tends to offer children with diagnosed DDH supportive rehabilitation methods that might enrich conservative treatment set by an orthopaedist. Cooperation with physiotherapists after successful treatment of children with DDH not only after surgical operations, but also after conservative treatment application is also developing. Children are often left to their own development after removal of abduction aids, which may be dangerous for future interplay of muscles (not activated before) after a long period of movement restriction. Qualitative research method in the form of elaborated case study of one patient with diagnosed DDH was chosen for the practical part. The thesis includes an introductory as well as final kinesiological analysis, description of the therapy course, the evaluation itself, communication with the mother and the physiotherapist in charge of the rehabilitation. The aim of the thesis was to point out the inseparable role of physiotherapy in treatment of children with DDH, to propose possible rehabilitation techniques for DDH treatment and to outline the way how Vojta method affects congenital hip joint disorders.
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