By: Andrew Mutnick, M.D. Learning Objectives:
- Understand fundamentals of hip development and hip pathology associated with DDH.
- Develop an approach to the infant hip exam and describe specific physical exam techniques.
- Gain knowledge of risk factors for DDH
- Understand the use of radiologic modalities in diagnosing DDH
- Demonstrate an understanding of management and treatment of DDH
1) You are seeing a 10-day-old newborn girl for her first visit. You have completed the history and have begun your examination. As you approach the hip exam, the words Ortolani, Barlow, Galeazzi, and Allis flood your mind. You take a deep breath and freeze time. What is DDH? Describe your understanding of hip development and your overarching concerns about infant hips.
2) You are now ready to perform the hip exam. Describe your approach. What are the Ortolani and Barlow maneuvers? What is the Galeazzi test? Are there other physical exam maneuvers you will perform to assess this infants hips?
3) On exam you detect a high-pitched click – NOT a loud clunk - on the right side upon Ortolani maneuver. The remainder of the exam is normal. What do you do? Are there any historical elements that might influence your next move?
4) You continue to follow this adorable infant and conduct a complete hip exam at each well-infant visit. At the 4-month visit you detect a limitation of movement with Ortolani on the left side, but no palpable clunk with either Ortolani or Barlow test. You also notice an asymmetry of gluteal folds with the left fold more proximal than right. You suspect left hip pathology but think you may be overcalling it without a positive instability test. How can you explain your findings? What is your next move?
5) If indeed this infant has DDH how will she be treated and followed?
RESOURCES:
AAP Practice Parameter 2000 (link)
Goldberg. Pediatrics in Review 2001 - Review of Practice Parameters (link)
DDH Figures (From Peds in Review Article)
