Developmental dysplasia of hip: Difference between revisions
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*<3mo: [[ultrasound]] Hip | *<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' | ||
Revision as of 12:29, 25 September 2017
Background
- Due to abnormal relationship of femoral head to acetabulum, usually in otherwise healthy infants prior to or shortly after birth
- <2% incidence
- 4-6X more common in girls
Clinical Features
- Early: see asymm soft tissue folds in groin, buttock & thigh, limb may be pulled prox & short
- 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
- Older: ORIF