How Common Is Developmental Dysplasia of the Hip in Infants With Breech Presentation?

Discussion Developmental dysplasia of the hip (DDH) includes several abnormalities where the femoral head and the acetabulum are not aligned normally or grow abnormally. This includes hips that are dislocatable, dislocated, dysplastic and subluxed. The natural history and pathophysiology are poorly understood. Screening can lead to earlier identification, but there are high rates of spontaneous resolution in the newborn period that require no intervention. Resolution rates are 60-80% if identified by physical examination and 90% resolve if identified by ultrasound examination in studies. Physical examination screening includes the Barlow and Ortolani examinations. Barlow examination is the adducting of a flexed hip with posterior force to identify a dislocatable hip. Ortolani examination is the abducting of a flexed hip with anterior force to relocate a dislocated hip. Some people remember Barlow is “back” (gentle force to push the femoral head backward) and Ortolani is “out” (the femoral head is out of place and is realigned with the gentle anterior force). These maneuvers can be difficult to perform in a manner that provides consistent accuracy. A review of other physical examination signs can be found here. Ultrasound examination is another screening and diagnostic technique. In some studies ultrasound has a high false-positive rates which could lead to unnecessary treatment and followup. It is felt that this is due to operator dependence. In oth...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news