The Reliability of Measurements of Pelvic Radiographs in Infants

We have evaluated the reliability of the measurement of radiological indicators in developmental dysplasia of the hip. Three observers each independently assessed 60 pelvic radiographs from infants aged from 3 to 36 months. Errors from the true value of a single measurement made by a single observer (E1), of the average of two measurements by a single observer (E2), and of the average of two single measurements by two different observers (E3) were established for the acetabular index of Hilgenreiner, for the assessment of superior and lateral femoral displacement and for indicators of pelvic alignment. The errors for the assessment of the acetabular index were E1 +/- 5 degrees, E2 +/- 5 degrees, and E3 +/- 3.5 degrees. There was a significant correlation between the presence of an acetabular notch on the radiograph and an increased error in measurement (p = 0.01). Yamamuro's measurement of lateral femoral displacement was more reliable than the Hilgenreiner distance. The errors of indicators of pelvic alignment showed a correlation with the age of the infant; the quotient of pelvic rotation was more reliable after seven months of age (p < 0.0001). The errors of the measurement of the symphysis os-ischium angle tended to increase with age and those of the measurement of the index of pelvic tilt decreased with skeletal maturation (p = 0.002).