QuestionSBA
QuestionChoice
This newborn has a positive Ortolani and therefore investigation and prompt treatment are indicated
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Reassure and discharge
QuestionChoice
Ultrasound examination is indicated in this baby, however serial ultrasounds are not of benefit, particularly if developmental dysplasia is detected as it does not treat the problem.
In babies where there is no clinical suspicion of developmental dysplasia, Public Health England does not recommend routine ultrasound examination unless specific risk factors are present:

1. There is a first-degree family history of hip problems in early life unless DDH was definitively excluded.
2. There is a breech presentation:

- At or after 36 completed weeks of pregnancy, irrespective of presentation at delivery or mode of delivery; or
- At delivery if this is earlier than 36 weeks.
- In the case of a multiple birth, if any of the babies fall into either of these categories, all babies in this pregnancy should have an ultrasound examination
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Serial ultrasounds
QuestionChoice
Bracing is the first line treatment in newborns when developmental dysplasia. Whilst physiotherapy may be of benefit in older children who are not diagnosed in childhood in a newborn this is not the correct management
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Physiotherapy
QuestionChoice
This baby has a positive Ortolani's test and an ultrasound suggestive of developmental dysplasia of the hip. Risk factors include: breech presentation, female gender, family history of developmental dysplasia.

Early detection and management are key, with bracing as the first-line treatment. Surgery is reserved for those who do not respond to bracing or are diagnosed later (after six months of age) and where bracing is contraindicated (for example, if the hip is irreducible). Harness or splint treatment is much less successful if it is started after 6-8 weeks
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a
Hip bracing
QuestionChoice
Surgery is reserved for those who do not respond to bracing or are diagnosed later (after six months of age) and where bracing is contraindicated (for example, if the hip is irreducible). Harness or splint treatment is much less successful if it is started after 6-8 weeks
32654
b
Surgical fixation
QuestionComment
"A newborn baby is examined as part of the routine 6-week baby check and the on gentle gentle forward pressure of the left there is movement palpable suggesting that the hip is dislocated or subluxed, but reducible."

Quesmed please hire a proofreader, that is actually awful :/
22786
QuestionComment
I have officially applied for the job, hopefully they have the sense to get back to me and hire me! Or anyone else haha, it's needed!
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User
subscriber
Amnesia Defibrillator
QuestionComment
im cnofused is the baby 6w old or 4w old?
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User
subscriber
Axillary Stasis
User
subscriber
BruceMcCornKicker
QuestionComment
the on gentle gentle forward pressure of the left
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User
subscriber
canIhave12bottlesofbleachplease
Concept
Chapter
# Summary
 

Developmental Dysplasia of the Hip (DDH) is a congenital abnormality where the femoral head and the acetabulum do not articulate correctly. This condition can lead to easy dislocation and abnormal development of the joint. Key signs and symptoms include limited hip abduction, asymmetrical gluteal and thigh skinfolds, and limb length discrepancy. Barlow and Ortolani manoeuvres serve as primary screening tools. The condition's diagnosis mainly relies on hip ultrasonography. Management ranges from observation in mild cases to the use of a Pavlik harness or surgery in more severe cases.
 

# Definition
 

Developmental dysplasia of the hip (DDH) is a congenital abnormality of the hip joint in which the ball of the femur (femoral head) and the socket of the pelvis (acetabulum) do not articulate appropriately. This mal-alignment can result in the joint dislocating easily and continuing to develop abnormally.
 

# Epidemiology
 

The incidence of DDH varies worldwide, ranging from 1 to 34 cases per 1000 births. The variability is due to differing diagnostic criteria and screening practices among countries. In the UK, it is estimated to affect 1-2% of newborns. 

It is more common in the left hip than the right, but occurs bilaterally in 20% of cases. 
 

# Aetiology
 

DDH is commonly associated with certain risk factors known as the 5 Fs:
 

 -  Female: The condition is more prevalent in females in a 4:1 female-to-male ratio. 
 -  Firstborn: Firstborn children have a higher risk.
 -  Family history: DDH often runs in families.
 -  Frank breech presentation: Babies presenting buttocks or feet first in the womb have a 17-fold higher risk of DDH.
 -  Fluid: Low amniotic fluid levels (oligohydramnios) can increase the risk.

Other risk factors include:
 
 - Prematurity
 - Multiple pregnancy 
 - Neuromuscular conditions (i.e. cerebral palsy)
 

# Signs and Symptoms
 

Clinical presentation may vary based on age. In infants, key signs include:
 

 -  Limited hip abduction, especially when the hip is flexed.
 -  Asymmetry of gluteal and thigh skinfolds.
 -  Apparent limb length discrepancy.
 

In older children, the following signs may be present:
 
 - Galeazzi sign: Unilateral femoral shortening is a positive result. This may suggest DDH but it can also be due to other causes of discrepency of limb length. 
 -  Walking difficulties or a limp.
 -  Delayed walking.
 -  Waddling gait in bilateral cases.

In cases of bilateral DDH:
 
 - Waddling gait with hyperlordosis.
 - Typically it is difficult to diagnose as there is often less pronounced limb length discrepency. 
 

# Differential Diagnosis
 

Differential diagnoses for DDH include:
 

 -  **Transient synovitis**: Presents with acute onset of hip pain, refusal to bear weight, and fever.
 -  **Septic arthritis**: Similar to transient synovitis but with a high fever and systemic symptoms. Prompt diagnosis is crucial to prevent joint damage.
 -  **Legg-Calve-Perthes disease**: Typically presents in children aged 4-10 years with a gradual onset of limping, pain in the hip, thigh, or knee, and decreased range of motion.
 -  **Slipped Upper Femoral Epiphysis (SUFE)**: Common in obese preteens and teenagers. Symptoms include hip pain, limping, and sometimes knee pain.
 

# Investigations
 

Screening Examination
 
- Barlow (tests for posterior dislocation) and Ortolani (tests for relocation on hip abduction) manoeuvres are primary screening tools. 
- Both are used during the newborn physical screening examination and the infant screening examination at 6-8 weeks. 

For infants with risk factors (i.e. family history of DDH, breech presentation), then a screening ultrasound should be done within the first 6 weeks of life. 

If DDH is clinically suspected, hip ultrasonography should be ordered for confirmation, especially in infants less than 6 months of age. For older infants and children, pelvic radiography may be more suitable.
 

# Management
 

The management approach is largely dependent on the severity and age at diagnosis:
 

 -  In mild cases or those detected early, the condition may be self-limiting within the first few months of life.
 -  A Pavlik harness may be used to maintain the hip in a flexed and abducted position for 6-12 weeks.
 -  More severe cases, those diagnosed > 6 months of age, or those not responding to non-operative management, may necessitate surgical intervention for reduction and stabilization.
 
# Complications

DDH can result in degeneration of the hip joint and pain in the lower back and hip. It is responsible for approximately 1 in 3 hip replacements before the age of 60. 

# NICE Guidelines
 
[NICE Guidelines for Childhood Limp](https://cks.nice.org.uk/topics/acute-childhood-limp/diagnosis/differential-diagnosis/) 

# References 
 
 [NHS UK - DDH](https://www.nhs.uk/conditions/developmental-dysplasia-of-the-hip/)
 
 [Patient Info - Developmental dysplasia of the hip](https://patient.info/doctor/developmental-dysplasia-of-the-hip-pro)
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Developmental Dysplasia of the hip
Topic
29
Paediatrics
6531
Developmental dysplasia of the hip (DDH) is a condition where an infant's hip joint develops abnormally, leading to instability or dislocation, and is often treated with hip bracing, such as the Pavlik harness, to promote proper alignment and development.
A newborn baby is examined as part of the routine 6-week baby check and the on gentle gentle forward pressure of the left there is movement palpable suggesting that the hip is dislocated or subluxed, but reducible. Ultrasound examination is undertaken at 4 weeks of age which is suspicious of developmental dysplasia of the hip joint.

What is the correct management?
a