![]() ![]() "Patients with unstable hip examinations should be immediately referred without an ultrasound. "Hip ultrasounds are great screening tools for patients who have the risk factors noted above," says Dr. Patients at 6 to 8 weeks of age with ultrasound abnormalities also generally should be referred for pediatric orthopedic evaluation. And it is helpful for providers to know that this is an ultrasound study that requires significant skill, as cited in a study published in the Journal of the American Academy of Orthopaedic Surgeons. A low threshold for ultrasound is prudent to ensure early diagnosis and treatment. In addition, ultrasound imaging also should be obtained at 4 to 6 weeks of age when any risk factors are in place, including a first-degree relative with hip dysplasia or history of breech intrauterine positioning. Limited hip abduction on one or both sides is another physical exam finding that prompts ultrasound. Infants with an unstable hip generally should be seen by a pediatric orthopedic specialist within 1 to 2 weeks for prompt treatment. The sensation of the femoral head moving in, Ortolani sign, or out, Barlow sign, of the femoral head with a soft shifting or clunk should be the trigger for treatment or further imaging. The leg should be gently abducted and adducted. The child should be undressed, and the diaper removed. The baby should be examined while relaxed. Making the diagnosis in the newborn depends primarily on the hip exam, which generally should be performed routinely at each visit in infants. In addition, other risk factors include first born, breech position, a family history of DDH and oligohydramnios as supported by a study in The Journal of Bone & Joint Surgery. A strong association between the female gender and DDH has been shown, with 80% of those affected being female, according to a study in the Journal of the American Academy of Orthopaedic Surgeons. The cause of DDH is likely a combination of genetic and environmental factors. "This approach can prevent the 'missed' hip dislocation."ĭDH is a separate condition from neuromuscular hip dysplasia, which occurs most frequently in patients with spasticity. Milbrandt, M.D., an orthopedic surgeon and the chair of Pediatric Orthopedics at Mayo Clinic in Rochester, Minnesota. "Asking families about their history of DDH along with the presence of breech position during pregnancy can identify which patients can benefit from a careful examination and hip ultrasound," says Todd A. ![]()
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