Gonadal shield: is it the albatross hanging around the neck of DDH research?
Refereed conference paper presented and published in conference proceedings


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AbstractIntroduction and Objectives: Prospective RCTs and long-term studies are essential future directions for evidence-based practice in DDH however sufficient attrition of data(>20%) introduce bias and reduce research quality. Pelvic radiography is synonymous with DDH assessment for patients older than 6 months and so are the Gonadal Shield(GS) usage recommendations for Pediatric Pelvis X-rays to reduce radiation exposure to the pediatric gonads. However significant loss of diagnostic information, inadequate protection and suggested worse affection in females have been associated with GS usage. In DDH, a disease with 80 % female prevalence, the impact of GS on quality of radiographs may be worse with questionable protection. This study aims to objectively define implications of GS usage in DDH patients.
Materials and Methods: Pelvis X-rays of all DDH patients diagnosed in a year 2 at a tertiary level Pediatric Referral centre with written protocol for GS usage were evaluated. Images were reviewed for gender, GS presence, adequate gonadal coverage and obstruction of essential anatomical landmarks.
Results: Hundred and thirty-one Pelvis X-rays with DDH diagnoses (Age:1.25-6 years;108 female, 23 male Pelvises) were reviewed. Only 42.67%(56) Pelvis radiographs used GS despite protocol. Inadequate gonadal coverage was more common in female pelvises than males(79.2% vs 37.5%; p=0.03), overall 73.2%(41) of the pelvises had inadequate coverage. Useful Anatomical landmarks were obliterated in 58.9% of all the X-rays using GS, the number of X-rays with lost diagnostic information was significantly higher in females pelvises(66.67% vs 12.5%, p= 0.01). Gonadal coverage was adequate in 26.78%(15) X-rays with GS but anatomy was obliterated in 100% of these adequately covered female pelvises.
Conclusion: GS usage may result in substantial attrition of radiographic data in DDH patients. Presumptive preparation to brace an effect on power of study and avoidance in females in agreement with patients parents are possible solutions.
All Author(s) ListAnubrat Kumar, Alec L H Hung, Bobby KW Ng, Jack W.W Chau, Chun Yiu Jack Cheng
Name of ConferenceThe 37th European Paediatric Orthopaedic Society Annual Meeting (EPOS 2018)
Start Date of Conference11/04/2018
End Date of Conference14/04/2018
Place of ConferenceOslo
Country/Region of ConferenceNorway
Proceedings TitleJournal of Children's Orthopaedics
Year2018
Month4
Volume Number12
Issue NumberSuppl 1
Pages10 - 10
ISSN1863-2521
eISSN1863-2548
LanguagesEnglish-United Kingdom

Last updated on 2018-21-11 at 12:27