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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
- 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
- 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
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
References
