Hip Development, Theory And Examination

Question 1

Imagine you are explaining why we screen for DDH to parents

Answer 1

DDH is developmental dysplasia of the hips
1. for early identification of dislocated or dislocatable hip(s)
2. Referral is made and we can identify DDH through a selective USS
Therefore we can minimise the risk of long-term complications

Question 2

Describe hip development as if talking to a parent

Answer 2

The hip joint is fully formed by the 11th week, normal anatomy is the femoral head (the ball) is tightly fit into the acetabulum (the socket)

Question 3

Describe DDH

Answer 3

developmental dysplasia of the hip is referring to those born with dislocation or instability of the hip joints

Question 4

Describe the risk factors of DDH

Answer 4

first degree family history of early life hip problems (e.g.needing treatment, surgery, harness)
Breech presentation at or after 36/40
Breech presentation at time of birth between 28/40 and 40
All babies in a multiples pregnancy should have a hip USS

Question 5

Describe what we do during the hip exam of the SPEN

Answer 5

1. behaviour and movement
2. Symmetry of leg length
3. Level of knees and hips when bilaterally flexed (Allis sign)
4. Restricted abduction of hip in flexion (breaststroke)
5. Manipulation with the Barlow and ortolani procedures on each hip separately

Question 6

Describe what a screen positive results are

Answer 6

Difference in leg length
Knees at different levels when hips and knees bilaterally flexed
Restricted unilateral limitation of hip abduction (20° or more)
Gross bilateral limitation of hip abduction ( loss of 30° abduction or more)
Palpable clunk when undertaking the manoeuvres

Question 7

Describe the referrals

Answer 7

Babies more than or at 34 weeks with an abnormal clinical hip exam have a USS between 4-6 weeks
Discharged after a review of normal USS
or attend clinical assessment by orthopaedic specialist within 6 weeks

Question 8

Describe the procedure for a screen negative with risk factors

Answer 8

Referred and have a hip USS by 6 weeks

Question 9

Describe the treatment for DDH

Answer 9

Fabric splint called a pavlik harness

Question 10

If screen negative what should parents look out for

Answer 10

One leg longer than the other
A clink can be felt or heard in one or both hips
When crawling one leg drags
When walking their child limps or when starting to walk like a duck
One leg cannot be moved sideways as far as the other when nappy changing

Question 11

Describe one Health promotion

Answer 11

Baby carriers that promote flexion and abduction of the hip