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.[17]
The hip is flexed to 90° and abducted, with the examiner's fingers 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 pediatric orthopedist 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.[17]
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 pediatric orthopedist 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.[17]
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).[5]
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.[11]
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.[12][13][14][15][16]
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.[17]
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