DEVELOPMENTAL DYSPLASIA OF HIP

Question 1

Which gender is more likely to have developmental dysplasia of the hip?

Answer 1

Female 5:1

Question 2

What is the aetiology of developmental dysplasia of the hip?

Answer 2

Capsular laxity + shallow acetabulum → causing hip instability, subluxation, dislocation +/- acetabular dysplasia

Question 3

What is the screening for DDH?

Answer 3

• All newborn infants before discharge
• Six weeks
• High-risk infants selected for USS screening

Question 4

What are the 2 tests carried out in DDH screening at 6 weeks?

Answer 4

• Barlow’s test: can hip be dislocated?
• Ortolani’s test: is hip reducible?

Question 5

Which test can be used in infants over eight weeks to test for DDH?

Answer 5

Galeazzi sign: flexed knees and feet together; positive sign → affected femur looks shorter due to dislocated hip

Question 6

What two main signs do you expect to see in a child with bilateral dislocation of the hips?

Answer 6

• Exaggerated lumbar lordosis
• Limited hip abduction

Question 7

Describe the gait. What should you consider if a child has this gait?

Answer 7

Positive Trendelenburg test

Developmental dysplasia for hip

Question 8

What are the main investigations for DDH in under 6 months and over 6 months of age?

Answer 8

• <6 months: hip USS
• >6 months: AP pelvis X-ray. Shallow acetabulum and broken Shenton’s line

Question 9

What is the treatment of DDH in children under and over six months?

Answer 9

• Under six months: Pavlik harness
• Over six months closed or open reduction depending on age

EVERYONE: urgent referral to paediatric orthopaedic surgeon

Question 10

Give an early, intermediate and late complication of developmental dysplasia of the hip

Answer 10

• Early: inadequate reduction, dislocation
• Intermediate: acetabular dysplasia, avascular necrosis
• Late: early osteoarthritic changes

Question 11

What is causing the problem with this hip joint?

Answer 11

Acetabular dysplasia