Overview

• DDH → structural abnormality in the hips caused by abnormal development of the fetal bones during pregnancy.
  • Causes instability in hips and tendency for subluxation or dislocation.
  • Usually detected in neonates.
• Risk Factors → female (5x), first degree family history, breech presentation, multiple pregnancy, oligohydramnios, firstborn.

Making Diagnosis

Clinical Features

• O/E → asymmetrical leg length, reduced range of movement in hip or a limp.
  • An older child with missed DDH may present with a Trendlenberg gait and leg length discrepancy.

Investigations

• Screening → screened for on neonatal examination at birth (NIPE) and 6-8 weeks old.

  • Barlow Test → attempts to dislocate an articulated femoral head.

  • Ortolani Test → attempts to relocate a dislocated femoral head.

    <aside> 💡 B before O → need to dislocate first, then relocate.

    </aside>

• Diagnosis → ultrasound. If >4.5 months then x-ray is 1st line.

  • All breech babies ≥36 weeks gestation require USS for DDH screening at 6 weeks.
  • USS>X-ray in newborns → bones are largely composed of cartilage which does not appear on X-ray. Furthermore, exposure to radiation at such a young age should be avoided if possible.

Management Plan

• Indications for USS at 6 weeks to check for DDH → breech presentation at 36/40, breech delivery, family history (1st degree) of DDH.
• First Line (newborn, <6 months old) → pavlik harness (most resolve spontaneously by 3-6w).
  • Harness keeps hips flexed and abducted.
  • Worn constantly for several weeks.
  • Complications → avascular necrosis and femoral nerve palsy.
• Second Line (>6 months old) → surgery.

Complications →

Prognosis →