Hips

Question 1

What is Developmental Dysplasia of the Hip (DDH)?

Answer 1

A condition where the hip joint is dislocated/dislocatable or dysplastic at birth. Includes subluxation (partial dislocation) or full dislocation.

Question 2

Why screen for DDH in SPEN?

Answer 2

Early detection minimizes long-term complications (e.g., osteoarthritis, mobility issues) via timely intervention (e.g., Pavlik harness).

Question 3

Key embryology milestones in hip development?

Answer 3

• Week 7: Cleft forms in mesenchymal cells → defines acetabulum/femoral head.
• Week 11: Hip joint fully formed; femoral head fits tightly in acetabulum.
• Movement ↑ blood supply → acetabulum structure to go from shallow to deepen

Question 4

What are the major risk factors for DDH?

Answer 4

• Breech presentation (at/beyond 36 weeks or birth 28+ weeks).
• Family history of early hip treatment (splint/surgery).
• Multiple pregnancy (if any risk factors present, all babies need USS).
• Oligohydramnios, swaddling cultures, or intrauterine moulding (e.g., torticollis)

Question 5

A baby is born breech at 37 weeks. What’s needed?

Answer 5

Hip ultrasound by 6 weeks (even if clinical exam is normal).

Question 6

What should you observe in a hip exam?

Answer 6

• Leg length symmetry.
• Allis sign (uneven knee levels when hips/knees flexed).
• Restricted hip abduction (≥20° difference between sides).

Question 7

How to perform the Barlow maneuver?

Answer 7

1- Flex hips/knees to 90°.

2 - Adduct hip + gentle posterior pressure → feel for “clunk” (femoral head subluxing out).

Question 8

How to perform the Ortolani maneuver?

Answer 8

1 - Flex hips/knees to 90°.

2 - Abduct hip + lift greater trochanter → “clunk” = femoral head relocating into acetabulum.

Question 9

True or False: Skin crease asymmetry is a screen-positive finding.

Answer 9

False (removed from NIPE screening per PHE 2024). COMEBACK

Question 10

When to refer for ultrasound?

Answer 10

• Abnormal clinical exam (e.g., clunk, restricted abduction).
• Risk factors + normal exam → USS by 6 weeks.

Question 11

A baby has a positive Ortolani. Next steps?

Answer 11

Urgent referral for USS (4–6 weeks) + orthopaedic assessment.

Question 12

What is first-line treatment for DDH?

Answer 12

Pavlik harness (95% success if used full-time for 6 weeks).

Prevents hip extension/adduction; allows flexion/abduction.

Question 13

When is surgery indicated?

Answer 13

For severe cases or failed harness:

Open reduction (clear obstructing tissue).

Acetabular reshaping (for older infants).

Question 14

Baby born at 38+2 weeks, sibling had DDH. Referral?

Answer 14

Yes (family history) → USS by 6 weeks.

Question 15

Baby with clicky hip but normal exam. Action?

Answer 15

No referral (clicky hips often benign; advise parents to monitor for other signs).

Question 16

High-Yield Mnemonics

Answer 16

Barlow OUT, Ortolani IN”: Barlow dislocates, Ortolani relocates.

Risk Factors ABC: Anomalies (breech), Bloodline (family history), Crowding (oligohydramnios/multiples).