International Interdisciplinary Consensus Meeting on the Evaluation of Developmental Dysplasia of the Hip

Abstract

In September 2018, an international meeting of doctors of various disciplines, with expertise in the detection and treatment of DDH, was held in Csolyospalos, Hungary. The aim was to achieve consensus on the detection and early treatment of the condition and to develop a standardized system of teaching and training for hip ultrasound. There was strong agreement that US screening is essential. Specifically the Graf technique was selected as the technique of choice. Universal US screening was strongly favored. Screening should be carried out as soon as possible, but not later than the sixth week of age. US screening is cost-effective, does not result in overtreatment, and contributes to a reduction of long-term consequences. The essential principle of treatment is timely application of a device to achieve reduction, retention and maturation, by holding the hips in flexion, and a safe degree of abduction. It was agreed that the effectiveness of any screening policy depends on the correct scanning technique. Therefore, standardization of teaching and training of the Graf technique is mandatory. A unified teaching policy and materials should be developed for this purpose. Certification, re-certification and audit were discussed. The group, which has been formalized as the International Interdisciplinary Consensus Committee On DDH Evaluation (ICODE), will continue to meet and work towards establishing international consensus on DDH, standardizing and developing teaching and training of the Graf technique for hip US, and maintaining standards for detection and management.

Zusammenfassung

Im September 2018 fand in Csolyospalos, Ungarn, ein internationales Treffen von Fachärzten unterschiedlicher Disziplinen mit Expertise in der Diagnostik und Behandlung von DDH statt. Ziel war das Erreichen eines Konsenses zu den einzelnen Aspekten der DDH, die Entwicklung eines standardisierten Lehr- und Trainingssystems für die Anwendung von Hüftultraschall (US) sowie die Sicherung der Anwendungsqualität. Ein starker Konsens bestand darin, dass die klinische Untersuchung alleine unzureichend und eine Ultraschalluntersuchung unerlässlich ist. Die Methodik nach Graf wurde dabei als erste Wahl konsentiert. Ein möglichst vor der sechsten Lebenswoche durchgeführtes generelles US-Screening wurde stark favorisiert. Wesentliches Prinzip der US-gesteuerten Therapie ist dabei der möglichst frühe Behandlungsbeginn zur Reposition bzw. Retention und Nachreifung. Konsens bestand darin, dass die Effektivität eines Screenings stark von der korrekten Anwendung der Scan-Technik abhängt, weswegen eine standardisierte Ausbildung in der Methode nach Graf unerlässlich ist. Korrekt angewendet ist US kosteneffektiv, führt nicht zu Übertherapie und hilft, langfristige Folgen der DDH erheblich zu reduzieren. Daher sollen ein einheitlicher Lehrkatalog und Ausbildungsmaterialien entwickelt werden. Auch eine Zertifizierung, Re-Zertifizierung und mögliche Audits wurden eingehend diskutiert. Die Aufgabe des internationalen, interdisziplinaren Konsensuskomitees fur DDH Evaluation (ICODE) ist es, einen internationalen Konsens über Diagnostik- und Behandlungsstandards der DDH herzustellen sowie einen internationalen, standardisierten Lehr- und Ausbildungsplan in der Methodik nach Graf zu entwickeln und zu etablieren.

Key words

education - training - quality assurance - musculoskeletal system - pediatrics

• References

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