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Hip dysplasia
Updated by: Allison Duey-Holtz
Updated on: 8/2/17
Definition
Developmental abnormalities involving the relationship between the femoral head and the acetabulum
Diagnosis/symptoms
Signs and symptoms
Anatomic characteristics/exam findings:
- Birth to 4 months:
- Asymmetric frog hip abduction
- Positive Barlow or Ortolani
- Positive Galleazi
- 6 months and older:
- Asymmetric frog hip abduction
- Positive Galleazi
- Abnormal gait with unilateral toe walking or hyperlordosis
Hip “click” in isolation without other positive exam findings is not directly indicative of hip dysplasia; as opposed to the “clunk” sensation of positive Barlow and Ortolani Asymmetric thigh folds alone are not good predictors of hip dysplasia in absence of other positive exam findings
- Risk factors:
- Female
- Breech presentation
- Family history of DDH
- Inappropriate swaddling
DDH is present in 1 per 100 live births, whereas dislocation at birth is present in approximately 1 per 1,000 infants
- Children who have normal findings should continue to have their hips examined at each of the recommended health supervision visits until a normal gait is demonstrated
Causes
- Improper relative positioning of femoral head to pelvic acetabulum leads to dysplastic development.
- Laxity is expected in infants up to 6 weeks of life give they are born with inherent hip laxity due to systemically retained maternal estrogen and in order to allow delivery.
Treatment
Birth to 4-6 months (depending on patient size and tolerance): Pavlik Harness
>6 months to 2 years: Rhino hip abduction orthosis
>2 years: likely requires surgical intervention
Pending improvement with bracing; may require open or closed reduction with subsequent spica casting.
Referring provider's initial evaluation and management:
Diagnosis:
Differential diagnosis
- Spasticity/adductor muscle tightness or contracture
- Benign hip click
- Congenital coxa vara
- Congenital short femur
Diagnostic tests
- Birth to 6 months:
Dynamic hip ultrasound - 6 months and older:
AP/frog lateral pelvis X-ray
Babies with breech presentation who have normal ultrasounds at 6 weeks of life should have a pelvis X-ray at 6 months of age given risk of late onset DDH.
When to initiate referral/ consider refer to Orthopedic Clinic:
- If positive risk factors with no abnormal exam findings; recommend dynamic hip ultrasound at 6 weeks of life
- If ultrasound is normal, no referral required
- Recommend AP/frog lateral pelvis X-ray at 6 months if breech
- If positive clinical exam findings; refer to orthopedics:
- If positive Barlow or Ortolani; do not need ultrasound prior to appointment.
- If other other exam findings noted; order ultrasound (if pt <6 months) or pelvis X-ray (if pt >6 months) prior to appointment
What can referring provider send to Orthopedic Clinic?
1. Using Epic
- Please complete the external referral order
In order to help triage our patients and maximize the visit, the following information would be helpful include with your referral order:
- Urgency of the referral
- What is the key question you would like answered?
Note: Our office will call to schedule the appointment with the patient.
2. Not using Epic external referral order:
- In order to help triage our patients maximize the visit time, please fax the above information to (414) 607-5288
- It would also be helpful to include:
- Chief complaint, onset, frequency
- Recent progress notes
- Labs and imaging results
- Other Diagnoses
- Office notes with medications tried/failed in the past and any lab work that may have been obtained regarding this patient's problems.
Specialist's workup will likely include:
After referral to Ortho Clinic:
- Clinical exam:
- Evaluate for hip abduction
- Positive Barlow or Ortolani
- Positive Galleazi
-
Education to families on:
- Patient education: Hip healthy swaddling