Developmental dysplasia of hip: Difference between revisions
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==Background== | ==Background== | ||
{{Hip anatomy background images}} | |||
*Due to abnormal relationship of femoral head to acetabulum, usually in otherwise healthy infants prior to or shortly after birth | *Due to abnormal relationship of femoral head to acetabulum, usually in otherwise healthy infants prior to or shortly after birth | ||
*<2% incidence | *Rare: <2% incidence | ||
*4-6X more common in | *4-6X more common in females | ||
==Clinical Features== | ==Clinical Features== | ||
*Early: see | *Early: see asymmetric soft tissue folds in groin, buttock & thigh, limb may be pulled prox & short | ||
**Galeazzi sign: relative ipsilateral shortening of femur compared to contralateral side | |||
*Ortolani on ALL young inf in ED, flex hip & knee @ 90 degrees & the thigh is abducted, the lateral aspect of both thighs should touch the table, the dislocated side will be restricted & have "click" as head slips out of acetabulum | *Ortolani on ALL young inf in ED, flex hip & knee @ 90 degrees & the thigh is abducted, the lateral aspect of both thighs should touch the table, the dislocated side will be restricted & have "click" as head slips out of acetabulum | ||
**by 6 wk <30% will have + ortolani or bartlow | **by 6 wk <30% will have + ortolani or bartlow | ||
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==Evaluation== | ==Evaluation== | ||
*<3mo: [[ultrasound]] | *<3mo: [[ultrasound]] hip | ||
*>3mo: AP pelvis with both legs extended in neutral abduction | *>3mo: AP pelvis with both legs extended in neutral abduction | ||
*Shenton's line on XR (imaginary line continuous along inferior border of superior pubic ramus and medial neck of femur) | |||
*Shenton's line | |||
*Acetabular angle should be <30' | *Acetabular angle should be <30' | ||
==Management== | ==Management== | ||
*Refer ALL patients to pediatric orthopedist | *Refer ALL patients to pediatric orthopedist | ||
*0-6mo: Pavlik harness or spica | *0-6mo: Pavlik harness or spica splint | ||
* | *>6mo: ORIF | ||
==Disposition== | ==Disposition== | ||
*Per orthopedic surgery recommendation | |||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Latest revision as of 20:27, 26 February 2025
Background
- Due to abnormal relationship of femoral head to acetabulum, usually in otherwise healthy infants prior to or shortly after birth
- Rare: <2% incidence
- 4-6X more common in females
Clinical Features
- Early: see asymmetric soft tissue folds in groin, buttock & thigh, limb may be pulled prox & short
- Galeazzi sign: relative ipsilateral shortening of femur compared to contralateral side
- Ortolani on ALL young inf in ED, flex hip & knee @ 90 degrees & the thigh is abducted, the lateral aspect of both thighs should touch the table, the dislocated side will be restricted & have "click" as head slips out of acetabulum
- by 6 wk <30% will have + ortolani or bartlow
Differential Diagnosis
Pediatric limp
Hip Related
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
Other Causes of Limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
Evaluation
- <3mo: ultrasound hip
- >3mo: AP pelvis with both legs extended in neutral abduction
- Shenton's line on XR (imaginary line continuous along inferior border of superior pubic ramus and medial neck of femur)
- Acetabular angle should be <30'
Management
- Refer ALL patients to pediatric orthopedist
- 0-6mo: Pavlik harness or spica splint
- >6mo: ORIF
Disposition
- Per orthopedic surgery recommendation