Shenton’s line in DDH: useful, or useless?

J Larwood, W Hasan, R Connell, E Lindisfarne, K Elliott, A Aarvold

University Hospital Southampton NHS trust

The purpose of this study was to explore whether a broken Shenton’s line does truly indicate underlying pathology in children with developmental dysplasia of the hip (DDH).

Data was collected prospectively on all babies treated solely in Pavlik harness at our institute over an 18-month time frame. Babies were included in the study if they were clinically and radiologically normal at 5 years of age and had had anterior-posterior radiographs available from three time points: 1, 2, and 5 years of age.

There were 101 children (170 hips) with full imaging available for inclusion in this study. 55 (54%) of these children had a broken Shenton’s line(s) on radiographs at 1 year of age, 27 (26%) at 2 years of age, and 13 (13%) at 5 years of age, despite all children being clinically and radiologically normal, with all other radiological parameters within normal range. 14 (44%) of the 32 children with unilateral DDH had a broken Shenton’s line in the contralateral, non-diseased hip, at one or more time point.

Using Shenton’s line to interpret normality or pathology in paediatric hips is no better than flipping a coin. It should be interpreted with caution in the radiological assessment of children with DDH. A broken Shenton’s line appears to be a normal radiological variant in this age group.