Congenital Dislocation of the Hip/CDH (1)

Question 1

What occurs here?

When is this usually diagnosed?

What are its risk factors?

Answer 1

➊ Abnormality of the hip joint where femoral head and acetabulum don’t articulate properly during development, leading to hip instability and the tendency for subluxation or dislocation

➋ Either during newborn examinations or later in childhood when they present with hip asymmetry, reduced ROM, or a limp

➌ 5 F’s:
• Female
• Firstborn
• Family hx
• Fanny first (Breech presentation)
• Fluid (Oligohydramnios)

Question 2

Screening:
What are the suggestive findings O/E during newborn checks?

What are the 2 special tests done to check for CDH?

Answer 2

➊ • Different leg lengths
• Restricted hip abduction on one side
• Significant bilateral restriction in abduction
• Difference in knee level when hips are flexed
• Clunking of hips on special tests

➋ • Barlow test (posterior dislocation) – Babe on back with hips adducted, and hips and knees flexed to 90 degrees. Gently press down on knees to see if femoral head dislocates posteriorly.
• Ortolani test (relocation on hip abduction) – Baby on back with hip and knees flexed. Hold knees with thumbs on inner thigh and four fingers on outer thigh. Gently abduct the hips and apply pressure behind legs with fingers to see if hips dislocate anteriorly.

Question 3

Which imaging is used to diagnose it?
→ What’s better in older infants?

What’s the prognosis for mild cases?

What are the ways in managing more severe cases?

Answer 3

➊ Hip US
→ XR

➋ Will be self-limiting within first few months of life

➌ • If baby presents < 6 months of age – Pavlik harness, which holds the femoral head in place to allow the acetabulum to develop in a normal shape (keeps hips flexed and abducted), and is removed once hips are more stable (Usually after 6-8 wks)
• Surgery required if harness fails or baby diagnosed after 6 months of age