Hip assessment

Question 1

Risk factors for DDH include:

Answer 1

-female (4x times higher than males)
- breech presentation
-family history
-first born child
-twins
-tight wrapping with legs held straight
-birthweight over 4000g

Question 2

DDH is also associated with:

Answer 2

• tortocollis and plagiocephaly
  -foot deformities
  -oligohydramnios

Question 3

What percentage of infants with DDH have no identifiable risk factors?

Answer 3

60%

Question 4

Hip stability - Ortolani & Barlow test age range:

Answer 4

8 week check.

Question 5

Ortolani test identifies:

Answer 5

Hip dislocation

Question 6

Ortolani test is positive if:

Answer 6

If a dislocated hip is manually reducible. A ‘clunk’ is felt when the dislocated head of the femur is relocated into the acetabulum.

Question 7

Ortolani procedure:

Answer 7

-Stabilise the pelvis - palm of hand on knee, middle finger placed over the greater trochanter and thumb grasping the inside of the knee.
-Flex the hip to 90° and hold leg in neutral rotation.
-Gently abduct the hip, while applying gentle pressure with the middle finger to elevate the greater trochanter.

Question 8

Barlow test identifies:

Answer 8

Hip instability

Question 9

Barlow test is positive if:

Answer 9

A gentle posterior force will cause a dislocatable hip to palpably slip out over the posterior rim of the acetabulum. Nurse ‘may’ feel a palpable clunk of dislocation.

Question 10

Barlow procedure:

Answer 10

-Stabilise the pelvis with fingers of one hand under the sacrum and the thumb over the symphysis pubis.
-Place the palm of other hand over the knee of the leg that is being examined, with the middle finger placed on the greater trochanter and the thumb on the inner thigh.
-Slowly adduct the thigh while applying gentle pressure backward and downward towards the examination surface.

Question 11

Limited hip abduction (3 months till walking independently) done at the 4 month check and checks for:

Answer 11

Restriction in hip abduction.
Normal range is equal to or greater than 60°.

Question 12

Limited hip abduction procedure:

Answer 12

Thighs are abducted simultaneously.
-Flex hips to 90°.

Question 13

Limb length discrepancy - Galeazzi positive sign (4 month check):

Answer 13

The knee on affected side will be lower than the knee of the unaffected leg, due to contracted hip muscles.

Question 14

Galeazzi procedure:

Answer 14

-Place infant supine, pelvis stabilised and level.
-Flex hips to 90° in neutral adduction/abduction and knees flexed.
-Face infant with eyes at level of infant’s knees.
-Assess for knee height assymmetry.

Question 15

Asymmetrical skin folds (from birth onwards) procedure:

Answer 15

-Place infant prone, with pelvis even.
-Check thigh and gluteal folds for asymmetry.

Question 16

Asymmetrical thigh folds alone are:

Answer 16

A soft sign of unilateral DDH. They area more reliable sign if associated with uneven gluteal creases.

Question 17

Gait abnormality for children who walk independently. Not reliable if child walking unsteadily or with support. Observe for:

Answer 17

-Unilateral toe walking
-Limp
-Trendelenberg gait (lurching gate as trunk moves side to side).
-Waddling gait.

Question 18

Unilateral DDH may cause:

Answer 18

-Trendelenberg gait (lurching) or
-Unilateral toe walking because of the shortened limb.

Question 19

Bilateral DDH may cause:

Answer 19

A duck-like waddling gait with hyperlordosis.

Question 20

Review and Referral:

Answer 20

Consider a timely review for reassessment if infant/child is uncooperative.
-For any deviations refer to a GP.
-Infants less than 4 months (corrected age) may be referred directly to PCH Orthopaedic Clinic. PCH accepts referrals for asymmetrical thigh creases alone.

Question 21

Referral documentation:

Answer 21

-CHS663 Clinical Handover, and provide parent with completed form.
-Document referral in CDIS, attach copy of CHS663
-Update CHS725 Consent for Release of Information if required.
-Follow up with parent re outcome of any referrals made.