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Paeds Vivasrheumatology-musculoskeletal-and-sports

Paeds Vivas · rheumatology-musculoskeletal-and-sports

Developmental dysplasia of the hip — branching viva

Branching viva on developmental dysplasia of the hip: performing the Ortolani and Barlow tests, grading the infant hip with the Graf ultrasound, choosing the age-stratified management, and catching the late-presenting toddler whose painless limp declares a hip that screening missed.

branching clinical structured oral1 min readVerification in progress

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
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Study tools

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Outpatient clinic: a five-week-old girl born in the breech position has a clunk on the left Ortolani test and a Graf type III hip on ultrasound. The examiner asks: describe your Ortolani and Barlow examination, give your Graf classification and thresholds, and state your management — then branches to the three-week reduction check, the abandonment of the harness to avoid avascular necrosis, the differential of the clunk versus the click, and finally to a two-year-old with a painless limp that reframes the diagnosis as a late-presenting dislocation.

Opening question

A five-week-old girl born in the breech position has a clunk on the left Ortolani test and a Graf type III hip on ultrasound. Describe your Ortolani and Barlow examination, state the Graf alpha-angle thresholds, and give your management. [1] [2]

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References4ShowHide
  1. [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. [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. [3]Tibrewal S, Gulati V, Ramachandran M. The Pavlik method: a systematic review of current concepts J Pediatr Orthop B, 2013.PMID 23995089
  4. [4]Terjesen T, Horn J. Have Changes in Treatment of Late-detected Developmental Dysplasia of the Hip During the Last Decades Led to Better Radiographic Outcome? Clin Orthop Relat Res, 2016.PMID 26290341
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