Late diagnosis of evolutionary hip dysplasia in the Costa Rican child population in the period 1996-2000

Abstract

Late diagnosis of DDH is an important public health issue,the purpose of this project is to make the medical communityaware of the problem and to emphasize on early detection.The aim is to analyze the cases of DDH with delayeddiagnosis, seem at the National Children' s Hospital in SanJosé, Costa Rica.This is a retrospective study that analyzes medical charts ofpatients with DDH whose diagnosis were reached late andthat were hospitalized at the National Children' s Hospitalbetween the years of 1996 and 2000. The sample wasrandomized. The information was organized in a data basedesigned for this purpose. The information was presentedand analyzed by percentages, mean, standard deviation andthe relationships between them.The great majority of cases of DDH were found in San José,followed by Cartago and in third place Heredia. Most of thepatients were diagnosed between their first and fifth year ofage. The mean age of diagnosis was 3 years and 4 monthswith a standard deviation of 4.99. From the total population,82% of patients were female and 18% male. The mostfrequent type of dislocation site was left in 52% of the cases,right was found in 24.8% and bilateral in 20%. The ratiobetween left and right dislocation was 2.2:1.The most frequent presentation at birth was cephalic in62.9% of the patients, 26.7% were pelvic and it was notindicated in 10.5% of cases.Concerning the type of birth, 80% were vaginal and 19% bycesarean section, 7% of thecharts did not have thisinformation.The percentage of children born at term was 67.6%The great majority of patients in this study were diagnosedafter one year of age, when the defect became evident whilewalking. Of the total population, 98.5% had to be submittedto some kind of surgical treatment. Surgical interventionrepresents high costs for the institution, traumatic to thepatient and the results are frequently not optimal with manypossible complications.