Child with a Limp

Question 1

When does screening/hip examination occur?

Answer 1

Ideally it occurs:

• at birth
• weeks 1,2,3 and 8
• months 4, 8, 12
• and until 3-4 years

Question 2

How does DDH generally present?

Answer 2

• limb shortened
  
  • Galeazzi test = pelvis is level (flex both hips to 90 degrees and assess level of the knees)
• limitation of abduction (ROM, resistance)
• hip instability:
  
  • Barlow -
  • Ortolani - reducibility of dislocation
• those with high risk or abnormal screening should have US of hips. Can US up until 6mths of age.

Question 3

What is the treatment of DDH?

Answer 3

• <6weeks
  
  • bracing (Pavlik harness)
  • 3-4month trial to relocate
• >3months
  
  • may need arthrogram
  • plaster jacket
  • open surgical reduction
• after walking age
  
  • open reduction

Question 4

What are other packaging disorders?

Answer 4

• plagiocephaly - flat head
• torticollis
• hyperextended knees
• foot deformities (talipes)
  
  • calcaneovalgus (foot against shin)
  • metatarsus adductus (forefoot adduction)
  • club foot

Question 5

What are some RFs for DDH?

Answer 5

• female
• firstborn
• FHx (1st degree increases risk 4x)
• Intrauterine packaging (oligohydramnios, multiple pregnancies, large baby)
• swaddling (while legs are straight)
• others - scoliosis, Down’s, Larsen syndrome

Question 6

A 3 day old baby had a normal newborn check, and is ready to be discharged. The mother is anxious as she had DDH and required hip replacement at age 18. What do you do?

1. reassure her baby is normal
2. perform US as an inpatient orthopaedic review
3. perform US at 6 weeks
4. advise f/u with GP in 6 weeks
5. arrange XR at 3mths