Curriculum · Pediatric / Nutrition & Growth / EPI / Routine Child Examination
Developmental dysplasia of the hip
Causes and risk
The risk factors for developmental dysplasia of the hip in infants include a breech presentation in the third trimester, regardless of whether the delivery was cesarean or vaginal. The other indications to evaluate an infant for this condition are a positive family history, a history of previous clinical instability, parental concern, a history of improper swaddling, and a suspicious or inconclusive physical examination. Twin birth, a large-for-gestational age infant, and prematurity are not considered risk factors.
How it is diagnosed
The important examination is the Barlow test, the Ortolani test and the Galeezi test. Barlow is adduction and pushing posteriorly, with dislocation when it is positive. Ortolani is abduction and elevation, and when it is positive you feel a clunk. The diagnostic investigations are ultrasound and X ray. Ultrasound can be done until the age of 6 months, because of ossification of the femoral head; if the child is older than that, an X-ray pelvis should be done. In a 6-week-old infant with a positive Ortolani test in whom a Pavlik harness has been started, ultrasound is the imaging modality used at the two week follow-up visit, rather than MRI, CT, plain radiographs or arthrogram and dynamic fluroscopy.