Developmental dysplasia of the hip

Question 1

Hx

Answer 1

6 wk baby check, asymmetry of child’s thigh folds. First child, breech delivery. Two family members had children with hip problems when they were born

Question 2

look/inspect

Answer 2

asymmetric thigh folds

Question 3

feel & move [active, passive, resisted]

Answer 3

doesn’t apply

Question 4

special tests

Answer 4

Barlow and Ortolani tests positive

Question 5

DDx

Answer 5

DDH

Traumatic dislocation

Question 6

Why is DDH likely?

Answer 6

Hx: breech delivery, pos FHx, female gender
Exam: asymmetric thigh folds, Barlow and Ortolani test positive

Question 7

Why is traumatic dislocation of hip unlikely?

Answer 7

no hx of trauma

baby is not irritable

Question 8

Investigations

Answer 8

U/S

X-ray

Question 9

U/S useful when and for what?

Answer 9

useful until child 3-5 months of age

evaluates acetabular dysplaasia and presence/absence of hip dislocation

Question 10

Xray AP pelvis useful when and for what?

Answer 10

useful when child is over 5 months

evaluates hip dislocation and hip dysplasia

Question 11

GP management

Answer 11

urgent referral to paeds ortho OPD

Question 12

Paeds ortho team non-op tx

Answer 12

abduction splinting/ bracing [Pavlik’s harness]

closed reduction and SPICA casting

Question 13

Paeds ortho team op tx

Answer 13

open reduction and SPICA casting

open reduction and femoral/pelvic osteotomy