Developmental dysplasia of hip

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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 hip pain

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

Disposition

See Also

References