Developmental dysplasia of hip: Difference between revisions

Latest revision as of 20:27, 26 February 2025

Background

Hip anatomy.

Extracapsular ligaments (anterior right hip).

Extracapsular ligaments (posterior right hip).

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

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

References

Authors:

@@ Line 1: / Line 1: @@
 ==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
+*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
--D/t abnormal relationship of fem head to acetabulum, usu in o/w healthy infants prior to or shortly after birth
+==Differential Diagnosis==
+{{Pediatric hip DDX}}
--<2% incidence
+==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'
--4-6X more common in girls
+==Management==
+*Refer ALL patients to pediatric orthopedist
+*0-6mo: Pavlik harness or spica splint
+*>6mo: ORIF
+==Disposition==
+*Per orthopedic surgery recommendation
-==Diagnosis==
+==See Also==
+*[[Pediatric hip pain]]
+==References==
+<references/>
-Early: see asymm soft tissue folds in groin, buttock & thigh, limb may be pulled prox & short
+[[Category:Pediatrics]]
+[[Category:Orthopedics]]
-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
-<3mo: Utz hip
->3mo: AP pelvis with both legs extended in neutral abduction
--Shenton's line
--Acetabular angle should be <30'
-==Treatment==
--Refer ALL pts to pediatric orthopedist
--0-6 mo pavlik harness or spica
--Older=orif
-[[Category:Peds]]