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Reading: Are two views of the pelvis routinely required in the assessment of the limping child?

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Research Articles

Are two views of the pelvis routinely required in the assessment of the limping child?

Authors:

S D Abeynayake ,

Colombo North Teaching Hospital, Ragama, LK
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M R Jackson

Royal Victoria Infirmary, Newcastle Upon Tyne, GB
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Abstract

Introduction: Atraumatic hip pain presenting with a limp is a common clinical problem in children. It is considered a diagnostic challenge to the physician.

Objectives: Aim of this study was to assess the sensitivity of a single view of the pelvis in radiographic imaging of a limping child.

Methodology: Retrospective analysis of all paediatric pelvic radiographs performed in Great North Children’s Hospital, Royal Victoria Infirmary, Newcastle upon Tyne, UK from 2004 to 2014 was carried out. 143 cases were recruited, in whom both AP and FL views had been performed at presentation, and a cause for hip pain had been identified based on the radiological report. These 286 radiographs were anonymised and randomly shuffled with 100 age-matched controls (50 AP / 50 frog-lateral) selected from normal radiographs within the same period to avoid bias. The images were independently reviewed by three consultant paediatric radiologists.

Results: Perthes/Avascular necrosis (AVN) (n=117) was identified with 94.6% sensitivity on the AP view compared to 94.3% on the frog-lateral view. Sensitivity for Slipped Upper Femoral Epiphysis (SUFE) (n=19) was 75.4% on AP and 100% on frog-lateral. Seven cases of other pathologies were identified with sensitivity of 61.9% on AP and 57.2% on frog-lateral.

Conclusion: Frog lateral view is superior to AP view in detection of SUFE and comparable in sensitivity for Perthes to the AP view. We suggest only the frog-lateral view is required in the routine assessment of the limping child.

How to Cite: Abeynayake, S.D. & Jackson, M.R., (2016). Are two views of the pelvis routinely required in the assessment of the limping child?. Sri Lanka Journal of Radiology. 2(1), pp.10–17. DOI: http://doi.org/10.4038/sljr.v2i1.28
Published on 25 Aug 2016.
Peer Reviewed

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