Question
A newborn girl presented with a click sound when the legs moved apart.In the management ,the doctor,used following brace on the patient as shown in the image.What is the most probable diagnosis?
A. Pelvis fracture
B. Bilateral acetabular fracture
C. Genu varum
D. Developmental Dysplasia of Hip
Show Answer
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Correct Answer » D
Explanation
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Ans: D. Developmental Dysplasia of Hip
Brace shown in the image is Pavlik harness
Congenital dislocation of the hip ( hip dysplasia or developmental dysplasia of the hip).
- The femoral head is not stable within the socket (which is also known as the acetabulum).
- Girls are affected six times as often as boys. In one third of cases, bilateral affection occurs.
- The early sign of congenital hip dislocation is when a person is able to hear “clicking” sounds when the legs are moved apart from one another.
Screening:
- Ortolani maneuver :the examiner put the newborn baby in a position in which the contralateral hip is held still while the thigh of the hip being tested is abducted and gently pulled anteriorly. If a “clunk” is heard (the sound of the femoral head moving over the acetabulum), the joint is normal, but absence of the “clunk” sound indicates that the acetabulum is not fully developed.
- Barlow maneuver. It is done by adducting the hip while pushing the thigh posteriorly. If the hip goes out of the socket it means it is dislocated, and the newborn has a congenital hip dislocation.
Management
- 0-6 months
– Pavlik harness.
It is a soft harness-like device that has straps that hold the legs apart and bent at the knee, in an attempt to keep the femur (ball) in the acetabulum (socket) in the correct position.
- 6 Months – 2 years, failed Pavlik
– Closed reduction ± tenotomies, hip spica cast 3 months
- 2-3 years, failed closed reduction
– Open reduction
- 3+ years
– Open reduction ± femoral osteotomy ± pelvic
osteotomy.
