{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:42:04Z","timestamp":1790109724505,"version":"4.0.1"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T00:00:00Z","timestamp":1755129600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Developmental Dysplasia of the hip (DDH) is a common pediatric disorder screened for by antero-posterior (AP) pelvic radiographs in infants aged between 4\u20139 months. We chose from the radiographic indicators commonly used in the diagnosis the acetabular index, the Shenton line and the ossification and symmetry of the femoral head to assess for their reliability and variability among readers. In addition, this study aimed to obtain the mean age of appearance of the ossification center of the femoral head in the Lebanese population.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>149 pelvic AP radiographs of children between 4 and 9 months of age were collected. The criteria were assessed by three experienced readers: one orthopedic surgery fellow resident, one first-year and one second-year orthopedic surgery residents twice separated by a three-month interval.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The bivariate analyses found a difference in the right Acetabular angle and left Acetabular angle significantly in the first- and second-year resident with a p\u2009&lt;\u20090.01. No significant difference was found when comparing the readings of each reader independently for the other variables or with the fellow. We found a significant difference p\u2009=\u20090.047 when comparing the readings of the first-year resident and the fellow of the right AI. Whereas the left AI readings revealed significant differences between the fellow and the second-year resident (p\u2009=\u20090.008) and between the first and second-year residents (p\u2009&lt;\u20090.001). Inter and intrareader consistency was high for the Shenton line rupture and the appearance of the ossification center on the femoral head but none of the parameters proved sufficient to significantly be associated with an acetabular angle&gt; 30\u00b0. The average age of ossification center appearance in the Lebanese population was determined to be 5.57 months, aligning with global averages.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>These findings call for a diagnostic approach that integrates multiple parameters and focuses on the importance of standardized training to enhance the consistency of radiographic assessments. Further investigations should aim to establish more precise protocols and evaluate the diagnostic strength of individual parameters.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0329230","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T19:21:47Z","timestamp":1755199307000},"page":"e0329230","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Radiographic criteria in developmental dysplasia of the hip in late infancy, inter and intrareader agreement"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4526-694X","authenticated-orcid":true,"given":"Desiree","family":"Alam","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6918-5689","authenticated-orcid":true,"given":"Souheil","family":"Hallit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Mandour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boutros","family":"El Tannoury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Hassoun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick Sami","family":"Bou Haidar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majd","family":"El Hajj Moussa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Claude","family":"Lahoud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charbel","family":"Tawk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi","family":"Hoyek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,8,14]]},"reference":[{"issue":"2","key":"pone.0329230.ref001","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1302\/0301-620X.105B2.BJJ-2022-0547.R2","article-title":"MRI assessment of femoral head docking following closed reduction of developmental dysplasia of the hip","author":"Z Fu","year":"2023","journal-title":"Bone Joint J"},{"issue":"11","key":"pone.0329230.ref002","doi-asserted-by":"crossref","first-page":"242","DOI":"10.3390\/jimaging9110242","article-title":"Assessing Acetabular Index Angle in Infants: A Deep Learning-Based Novel Approach","volume":"9","author":"F Jan","year":"2023","journal-title":"J Imaging"},{"key":"pone.0329230.ref003","doi-asserted-by":"crossref","first-page":"186","DOI":"10.25259\/JMSR_45_2023","article-title":"Epidemiology of developmental dysplasia of the hip at a tertiary hospital in Oman","volume":"7","author":"MS Al Azri","year":"2023","journal-title":"JMSR"},{"issue":"4","key":"pone.0329230.ref004","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1177\/18632521241229978","article-title":"Globally inconsistent: Countries with top health indices erratic developmental hip dysplasia screening protocols","volume":"18","author":"NL Zusman","year":"2024","journal-title":"J Child Orthop"},{"issue":"8","key":"pone.0329230.ref005","article-title":"Developmental Dysplasia of the Hip (DDH): Etiology, Diagnosis, and Management","volume":"15","author":"K Bakarman","year":"2023","journal-title":"Cureus"},{"issue":"5","key":"pone.0329230.ref006","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1097\/BPO.0000000000000318","article-title":"Reliability of a New Radiographic Classification for Developmental Dysplasia of the Hip","volume":"35","author":"U Narayanan","year":"2015","journal-title":"J Pediatr Orthop"},{"issue":"12","key":"pone.0329230.ref007","first-page":"843","article-title":"Common questions about developmental dysplasia of the hip","volume":"90","author":"JC Jackson","year":"2014","journal-title":"Am Fam Physician"},{"issue":"8","key":"pone.0329230.ref008","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1097\/BPO.0000000000001602","article-title":"Even Experts Can Be Fooled: Reliability of Clinical Examination for Diagnosing Hip Dislocations in Newborns","volume":"40","author":"P Harper","year":"2020","journal-title":"J Pediatr Orthop"},{"issue":"6","key":"pone.0329230.ref009","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.3892\/etm.2014.2009","article-title":"Superiority of the modified T\u00f6nnis angle over the T\u00f6nnis angle in the radiographic diagnosis of acetabular dysplasia","volume":"8","author":"L Fa","year":"2014","journal-title":"Exp Ther Med"},{"issue":"1","key":"pone.0329230.ref010","article-title":"Prevalence of developmental dysplasia of the hip (DDH) in infants: a systematic review and meta-analysis","volume":"7","author":"Z Tao","year":"2023","journal-title":"BMJ Paediatr Open"},{"key":"pone.0329230.ref011","doi-asserted-by":"crossref","first-page":"47","DOI":"10.2106\/JBJS.H.00756","article-title":"A systematic approach to the plain radiographic evaluation of the young adult hip","author":"JC Clohisy","year":"2008","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"pone.0329230.ref012","doi-asserted-by":"crossref","first-page":"21","DOI":"10.52628\/89.1.7647","article-title":"T\u00f6nnis and the Novel IHDI Radiographic Classification Systems for the Developmental Dysplasia of The Hip (DDH): Evaluation of 406 hips with DDH","volume":"89","author":"S Yilar","year":"2023","journal-title":"Acta Orthop Belg"},{"issue":"9","key":"pone.0329230.ref013","article-title":"An Overview of Developmental Dysplasia of the Hip and Its Management Timing and Approaches","volume":"15","author":"A Alhaddad","year":"2023","journal-title":"Cureus"},{"issue":"1","key":"pone.0329230.ref014","doi-asserted-by":"crossref","first-page":"172","DOI":"10.2214\/AJR.20.23358","article-title":"Measuring the Acetabular Index: An Accurate and Reliable Alternative Method of Measurement","volume":"217","author":"B Sherman","year":"2021","journal-title":"AJR Am J Roentgenol"},{"key":"pone.0329230.ref015","doi-asserted-by":"crossref","first-page":"35","DOI":"10.2106\/JBJS.J.01717","article-title":"The Shenton line in the diagnosis of acetabular dysplasia in the skeletally mature patient","author":"PC Rhee","year":"2011","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"pone.0329230.ref016","doi-asserted-by":"crossref","first-page":"185","DOI":"10.21037\/qims-22-513","article-title":"Developmental retardation of femoral head size and femoral head ossification in mild and severe developmental dysplasia of the hip in infants: a preliminary cross-sectional study based on ultrasound images","volume":"13","author":"H Yan","year":"2023","journal-title":"Quant Imaging Med Surg"},{"issue":"3","key":"pone.0329230.ref017","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s11832-012-0406-2","article-title":"Reliability of plain radiographic parameters for developmental dysplasia of the hip in children","volume":"6","author":"VV Upasani","year":"2012","journal-title":"J Child Orthop"},{"issue":"2","key":"pone.0329230.ref018","doi-asserted-by":"crossref","first-page":"87","DOI":"10.2519\/jospt.2019.8476","article-title":"Accuracy of Clinical and Imaging Tests for the Diagnosis of Hip Dysplasia and Instability: A Systematic Review","volume":"49","author":"MP Reiman","year":"2019","journal-title":"J Orthop Sports Phys Ther"},{"issue":"3","key":"pone.0329230.ref019","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1097\/BPO.0000000000000791","article-title":"Normal Percentile Reference Curves and Correlation of Acetabular Index and Acetabular Depth Ratio in Children","volume":"38","author":"EN Novais","year":"2018","journal-title":"J Pediatr Orthop"},{"issue":"4","key":"pone.0329230.ref020","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1097\/BCO.0000000000001117","article-title":"Reliability of acetabular index measurement in developmental dysplasia of the hip screening by orthopaedic trainees: a comparative study","volume":"33","author":"ZO Elifranji","year":"2022","journal-title":"Current Orthopaedic Practice"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0329230","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T19:21:52Z","timestamp":1755199312000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0329230"}},"subtitle":[],"editor":[{"given":"Fahad Farhan","family":"Almutairi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,8,14]]},"references-count":20,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,14]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0329230","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,14]]}}}