Explain a positive newborn hip examination to a family — OSCE

OSCE communication and shared decision-making station: explaining the assessment and management of developmental dysplasia of the hip to the parents of a five-week-old breech-born girl with a clunk on Ortolani testing, addressing the Graf ultrasound grade, the Pavlik harness and its three-week check, the risk of avascular necrosis if the harness is continued when not reduced, and the reassuring prognosis of a hip treated early.

osce communication and shared decision-making2 min readVerification in progress

Prompt

The parents of a five-week-old girl are in the clinic after a clunk was felt on her left Ortolani test at the six-week check. She was born in the breech position, and a hip ultrasound has confirmed a Graf type III dysplastic hip. The orthopaedic team has recommended a Pavlik harness worn for twenty-three hours a day with an ultrasound check at three weeks. The parents are anxious, they think the clunk means the hip is dislocated and broken, and they are worried the harness will hurt their baby and that she will need surgery. Counsel them.

Candidate brief

You have eight minutes to counsel the parents of a five-week-old breech-born girl who has been diagnosed with developmental dysplasia of the hip after a clunk was felt on the Ortolani test and confirmed by a Graf type III ultrasound. Use a structured, honest, empathic approach that explains the condition in plain language, addresses the parents' fears about the harness and surgery, and builds a shared plan around the Pavlik harness and the three-week check. ^[1] ^[2]

References3Show

[1]Guille JT, Pizzutillo PD, MacEwen GD. Development dysplasia of the hip from birth to six months J Am Acad Orthop Surg, 2000.PMID 10951112
[2]Perry DC, Paton RW. Knowing your click from your clunk: is the current screening for developmental dysplasia of the hip fit for purpose? Bone Joint J, 2019.PMID 30813794
[3]Tibrewal S, Gulati V, Ramachandran M. The Pavlik method: a systematic review of current concepts J Pediatr Orthop B, 2013.PMID 23995089

Explain a positive newborn hip examination to a family — OSCE

osce communication and shared decision-making2 min readVerification in progress

Candidate brief

References3Show

[1]Guille JT, Pizzutillo PD, MacEwen GD. Development dysplasia of the hip from birth to six months J Am Acad Orthop Surg, 2000.PMID 10951112
[2]Perry DC, Paton RW. Knowing your click from your clunk: is the current screening for developmental dysplasia of the hip fit for purpose? Bone Joint J, 2019.PMID 30813794
[3]Tibrewal S, Gulati V, Ramachandran M. The Pavlik method: a systematic review of current concepts J Pediatr Orthop B, 2013.PMID 23995089