Developmental dysplasia of hip

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

• 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:
  • Appendicitis
  • Meningitis
  • Epidural abscess (spinal)

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

See Also

• Pediatric hip pain