Developmental dysplasia (Smarty PANCE)

What is developmental dysplasia of the hip?

In developmental (congenital) dysplasia of the hip, the femoral head dislocates out of its acetabulum during development, and as a result, the ball and the socket grow out of proportion to one another, so that they're unable to form a normal stable joint

Is hip dysplasia more likely to affect females or males?

Hip dysplasia affects females over males at an 8:1 ratio

How do children with congenital hip dysplasia present?

Children with congenital hip dysplasia present with legs of unequal lengths and asymmetric skin folds around the groin, and they may develop limping and waddling gait when they start walking.

What are risk factors for congenital hip dysplasia?

High risk factors include:

● Breech presentation

● Presence of other deformities (eg, torticollis, congenital foot deformity)

● Positive family history (particularly for girls)

Describe the Barlow maneuver?

The Barlow maneuver consists of adducting the hip while holding the knee straight, and when this pops the femoral head out of the socket, this raises suspicion of hip dysplasia

Describe the Ortolani maneuver?

The Ortolani maneuver consist of flexing the baby's hip at 90°, and then gently abducting it. If the femoral head is out of the socket, Ortolani maneuver will cause it to slip back into the acetabulum, which will feel and sound like a clunk.

Describe Galeazzi sign?

A difference in knee height when the child is supine with hips flexed, knees bent, and feet on the examining table (Galeazzi sign) suggests dysplasia

What imaging is recommended for diagnosis of developmental dysplasia of the hip?

Ultrasonography of the hips is recommended at 6 weeks of age for infants at high risk, including those with a breech presentation, those born with other deformities (eg, torticollis, congenital foot deformity), and girls with a positive family history of developmental dysplasia of the hip. Imaging is also required when any abnormality is suspected during examination. Hip ultrasonography can accurately establish the diagnosis earlier in life. Hip x-rays are helpful after the bones have started to ossify, typically after age 4 months

What is the treatment of congenital hip dysplasia?

Treatment depends on age of diagnosis

< 6 months: Pavlik harness (abduction bracing)

6-15 months: hip spica cast

15-24 months: open reduction followed by hip spica cast

Make sure to monitor for what complication?

Make sure to monitor for osteonecrosis until age 6