Paeds Elective iSAWE 1

Risk factors and examination

• Breech presentation, female sex, first born, family history and oligohydramnios
• Other packaging conditions such as torticollis and metatarsus adductus
• Barlow and Ortolani tests in the first months, then limited abduction, Galeazzi sign and leg length difference
• Bilateral dislocation may only show symmetrical limited abduction

Imaging

• Ultrasound before about 4 to 6 months, using the Graf alpha angle (normal 60 degrees or more) and femoral head coverage
• AP pelvis radiograph after the femoral head ossifies, using Hilgenreiner and Perkin lines, Shenton line and acetabular index

Management by age

• Birth to 6 months, Pavlik harness, checking reduction with ultrasound and stopping if not reduced by 3 weeks
• 6 to 18 months, examination under anaesthesia, arthrogram, closed reduction with adductor tenotomy and hip spica, with open reduction if closed reduction fails
• Over 18 months, open reduction often with femoral shortening osteotomy and pelvic osteotomy
• Watch for avascular necrosis and residual dysplasia until skeletal maturity

Related pages

• Developmental Dysplasia of the Hip
• Pelvic Osteotomies