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Key Features

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  • Encompasses a spectrum of conditions where an abnormal relationship exists between the proximal femur and the acetabulum

  • Dislocatable hip

    • Most severe condition

    • Femoral head is not in contact with the acetabulum

    • Femoral head is within the acetabulum but can be dislocated with a provocative maneuver

  • Subluxatable hip

    • Femoral head comes partially out of the joint with a provocative maneuver

  • Acetabular dysplasia

    • Denotes insufficient acetabular development

    • Radiographic diagnosis

  • Congenital dislocation of the hip

    • More commonly affects the left hip, occurring in approximately 1–3% of newborns

    • At birth, both the acetabulum and femur are underdeveloped

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Clinical Findings

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  • Clinical diagnosis depends on demonstrating the instability of the joint by placing the infant on his or her back and obtaining complete relaxation

  • Ortolani sign

    • The examiner's long finger is placed over the greater trochanter and the thumb over the inner side of the thigh

    • Both hips are flexed 90 degrees and then slowly abducted from the midline, one hip at a time

    • With gentle pressure, an attempt is made to lift the greater trochanter forward

    • A feeling of slipping as the head relocates is a sign of instability

  • Barlow sign

    • When the joint is more stable, the deformity must be provoked by applying slight pressure with the thumb on the medial side of the thigh as the thigh is adducted

    • As hip slips posteriorly, it elicits a palpable clunk as the hip dislocates

  • Limited hip abduction of less than 60 degrees while the knee is in 90 degrees of flexion is believed to be the most sensitive sign for detecting a dysplastic hip

  • Galeazzi sign

    • The signs of instability become less evident after the first month of life

    • If the knees are at unequal heights when the hips and knees are flexed, the dislocated hip will be on the side with the lower knee

  • Trendelenburg sign

    • When the child stands on the affected leg, a dip of the pelvis is evident on the opposite side due to weakness of the gluteus medius muscle; this accounts for unusual swaying gait

    • If dysplasia of the hip has not been diagnosed before the child begins to walk, there will be a painless limp and/or a lurch to the affected side

  • As a child with bilateral dislocation of the hips begins to walk, the gait is waddling

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Diagnosis

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  • Ultrasonography

    • Most useful in newborns

    • Can be helpful for screening high-risk infants, such as those with breech presentation or positive family history

  • Radiography

    • More valuable after the first 6 weeks of life, with lateral displacement of the femoral head being the most reliable sign

    • In children with incomplete abduction during the first few months of life, a radiograph of the pelvis is indicated

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Treatment

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  • Early treatment produces better outcome

  • Pavlik harness

    • Maintains reduction by placing the hip in a flexed and abducted position

    • Can be easily used to treat dislocation ...

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