key: cord-0961311-6wy2jh3m
authors: Buonsenso, Danilo; Menzella, Nicoletta; Morello, Rosa; Valentini, Piero
title: Indirect effects of COVID-19 on child health care: delayed diagnosis of developmental dysplasia of the hip
date: 2020-07-02
journal: J Ultrasound
DOI: 10.1007/s40477-020-00502-6
sha: b3a01d9af7c593383c655ed9a4fba50724723446
doc_id: 961311
cord_uid: 6wy2jh3m

nan

attention from another region, to perform a hip ultrasound. Clinically, the Ortolani-Barlow maneuvers were positive and her hip was dislocatable especially on the right side.

Subsequently, we performed the ultrasound examination according to Graaf [2] . The exam showed dysplasia with the shallow and underdeveloped acetabulum, subluxation with a displacement of the joint with some contact remaining between the articular surfaces and dislocation with a displacement of the joint with no contact between the original articular surfaces (Fig. 1) . Therefore, a delayed diagnosis of DDH was performed. Considering the stage of DDH and the child age an x-ray examination was required, showing bilateral hip dislocation and delay of ossification.

In this case, having the child a known risk factor for DDH, a screening ultrasound at 4 weeks of age was needed according to the last guidelines [2] . However, the family was not able to obtain an outpatient clinical visit, nor ultrasound evaluation. The family was only able to perform ultrasound at 5 months of age. If recognized at the proper timing, the infant would have probably benefited from non-invasive correction with the use of a harness or brace. In this case, treatment will be more complicated, including open reduction if closed reduction is not successful, with less predictable results. When diagnosed late, DDH can lead to pain and osteoarthritis by early adulthood, produce a difference in leg length or decreased agility. Even with appropriate treatment, hip deformity and osteoarthritis may develop later in life and require early surgical approach with a hip prosthesis.

Although COVID-19 has been shown to be mild in the majority of cases [5] , indirect effects related to the restrictive measures are having significant, not yet established, consequences on primary child health. Vaccination delays or missing of doses has been noticed by the American Academy of Pediatrics, but other primary care interventions are at risk as well. However, paediatricians must be committed in supporting parents in not-missing routine child well-being visits, since delays can cause unpredictable consequences, that would have been easily prevented, as in this case.

Developmental dysplasia of the hip in the context of the COVID-19 pandemic

International interdisciplinary consensus meeting on the evaluation of developmental dysplasia of the hip

Developmental dysplasia of the hip: real world data from a retrospective analysis to evaluate the effectiveness of universal screening

Preparedness and response to pediatric COVID-19 in European emergency departments: a survey of the REPEM and PERUKI networks

Coronavirus infection in pediatric emergency departments (CONFIDENCE) research group. Children with Covid-19 in pediatric emergency departments in Italy

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