Developmental dysplasia of the hip — formative SAQs

SAQ 1 (10)

A six-week-old girl born in the breech position at thirty-seven weeks is referred after her general practitioner felt a clunk on the left Ortolani test at the six-week check. She is otherwise well, with a normal developmental history. A coronal hip ultrasound reports a left Graf type III hip with an alpha angle of forty degrees. ^{[1] [2]}

a) Describe how to perform the Ortolani and Barlow tests on a newborn, naming the hand positions and the movement that each test provokes. (4 marks) ^[2]

b) State the Graf alpha-angle thresholds that separate a normal hip, an immature hip, a critical hip, and a dislocated hip. (4 marks) ^[1]

c) Outline the immediate management of this infant, naming the device, its target position, and the investigation that confirms reduction at three weeks. (2 marks) ^[3]