History and exam
Key diagnostic factors
common
positive Ortolani test
Used in infants <6 months of age, although the test begins to lose its sensitivity and usefulness around 3-6 months of age due to increased musculature.[18]
The hip is flexed to 90° and abducted, with the examiner's fingers are placed laterally over the greater trochanter of the hip joint. The examiner then uses anterior pressure over the trochanter in an attempt to identify a dislocated hip that is relocatable.
Should refer to a paediatric orthopaedist if frank instability is appreciated.
Care needed not to interpret a 'click' of hip or knee as a sign of instability.
positive Barlow test
Used in infants <6 months of age, although the test begins to lose its sensitivity and usefulness around 3-6 months of age due to increased musculature.[18]
The hip is flexed to 90° and adducted, the examiner's hand is placed on the knee, and posterior pressure is placed through the hip in an attempt to identify dislocatable hips.
Should refer to a paediatric orthopaedist if frank instability is appreciated.
Care needed not to interpret a 'click' of hip or knee as a sign of instability.
limited hip abduction
An assessment of abduction at the hip becomes the most important screening method in infants around 3 months of age.[18]
Other diagnostic factors
uncommon
abnormal positioning of the leg or delayed crawling/walking
In older infants and young children, these may be presenting symptoms reported by the parents.
toe-walking (especially unilateral)
Developmental dysplasia of the hip (DDH) should be considered in infants and young children who toe-walk (especially unilateral toe-walkers, indicating potential shortening on the affected side), even though most cases will not be caused by DDH.
Risk factors
strong
female sex
positive family history
Most population-based studies show that a family history of DDH is a stronger risk factor than breech positioning (relative risk ranges: 3.4 to 24.9).[6]
breech presentation
weak
postural deformity
Congenital muscular torticollis and postural foot deformities have been associated with DDH, but studies suggest the association may be less pronounced than initially believed.[12]
restricted intrauterine space
Few population-based studies have examined restricted uterine space as a consequence of first pregnancy, oligohydramnios, macrosomia, or multiple gestation in a rigorous way, either individually or collectively. Some studies have demonstrated a slightly increased risk of DDH whereas others have found no difference compared with control groups.[13][14][15][16][17]
incorrect lower-extremity swaddling
Swaddling that maintains the hips in an extended and adducted position has been associated with DDH. Safe swaddling techniques can lessen this risk.[18]
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