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Another health consequence of COVID-related diagnosis delays?

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There is a concern that cases of Developmental Dysplasia of the Hip (DDH) may increase due to COVID restrictions as a doctor cannot diagnose DDH via a virtual consultation.

DDH is a condition whereby the ball and socket hip joints fail to develop. It is prevalent in new-born’s and therefore can have long lasting consequences if it is missed or is not treated promptly.

With COVID restrictions leading to appointments being cancelled, or taking place virtually, this may impact on a timely diagnosis being made and have severe, lifelong consequences for many youngsters.

Early diagnosis only possible by physical examination

In order to diagnose DDH the treating clinician needs to undertake a physical examination to feel the hip socket and identify any possible discrepancies with the joint itself.  In most cases, if diagnosed early enough, DDH can be treated non-surgically via the use of a brace/cast which assists in fixing the femur head into the socket of the hip. It allows for the hip socket and femur head to realign naturally as young children continue to develop.

The potential impact of such a delay in diagnosis is illustrated by the case of an eight-year-old child who had been diagnosed with DDH and on whose behalf Shoosmiths were instructed to investigate a claim for potential clinical negligence earlier this year.

Background

Following birth, the infant was discharged without the appropriate checks being carried out on the condition of her hips. Children are due to be checked six - eight weeks following birth, at which point the hips are also examined. Unfortunately, such an examination for DDH was not made at discharge or during her eight-week check.

Over the course of the next 12 months, no degenerative changes were noted. However, several days after her first birthday, she began to take her first steps and walk. Her mother noticed her left leg was ‘dragging’. This continued for several weeks, at which point her mother took her to the GP. The dragging leg was noticeably longer than the other, which prompted further inspection. The GP referred the youngster to a specialist orthopaedic consultant who arranged an x-ray which confirmed that she was suffering with severe developmental dysplasia of the hip. The x-ray showed that her hip joint was completely separated from the socket.

Delayed diagnosis means more invasive surgery for youngsters

Unfortunately, due to the length of time taken in identifying the condition, the only possible treatment open by that time was the most invasive form of treatment - open reduction surgery. This is carried out under general anaesthetic and involves the surgeon making a cut in the groin and opening up the hip joint. The damaged tissue is then removed and the ball joint of the femur (thigh bone) is aligned back into the acetabulum (hip socket).

Investigations are ongoing to determine how the severe delay in diagnosis has impacted our young client’s future prognosis. Jayesh Patel, who is acting in the case described, says:

“Unfortunately, as in this example, if cases are not being picked up as quickly as they may have been prior to COVID lockdown restrictions and difficulty in getting face-to face appointments with clinicians, this could lead to many more young children needing to endure more extensive and invasive open reduction and hip reconstruction procedures rather than less traumatic or painful treatments in order to correct DDH.”

Our young client’s mother commented:

“Shoosmiths have been very supportive, but our situation highlights just how important it is to follow up, ask questions, and chase for appointments when they seem to be taking too long.  if we hadn’t, there’s a chance my daughter would been waiting even longer than she already had to receive the treatment she needed. Even if you think it’s nothing, get it checked, ask more questions, because the sooner it’s identified the sooner it can be treated with as little impact as possible in future.”

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