Developmental dysplasia of the hip is abnormal growth of the hip joint in infants, ranging from a shallow socket to a fully dislocated hip. Found early, it is usually treated with a soft brace; found late, it can cause a limp and early arthritis.
Key symptoms
- Often no symptoms in newborns
- Uneven thigh or buttock skin folds
- One leg looks shorter
- Limp, toe walking or waddling gait in walking children
What you find on exam
- Barlow test: a hip that can be pushed out of the socket
- Ortolani test: a clunk as a dislocated hip slides back in
- Limited hip abduction after 3 months of age
- Galeazzi sign: knees at different heights
Tests
- Hip ultrasound in infants younger than about 4 to 6 months
- Pelvic X-ray after about 4 to 6 months, once the femoral head ossifies
- Risk factors: breech position, family history, female sex, firstborn
Treatment basics
- Pavlik harness in infants up to about 6 months
- Closed reduction and spica cast if the harness fails or after 6 months
- Open reduction or pelvic surgery in older children
- Avoid tight swaddling with the legs straight
Red flags
- Positive Barlow or Ortolani test
- Limp or leg length difference in a walking child
- Breech birth with an abnormal hip exam
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.