Endgames Case report

Clinical examination for developmental dysplasia of the hip in neonates: how to stay out of trouble

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1965 (Published 12 May 2010) Cite this as: BMJ 2010;340:c1965
  1. D M Eastwood, consultant in paediatric orthopaedics,
  2. A de Gheldere, clinical fellow
  1. 1Royal National Orthopaedic Hospital, Stanmore
  1. Correspondence to: A de Gheldere digheldria{at}gmail.com

    A two week old baby girl was referred to the orthopaedic department by her local consultant in neonatology because of concerns regarding her left hip.

    The patient was born at 39 weeks by spontaneous vertex delivery and had a birth weight of 2.82 kg. Although the fetus had laid abnormally during pregnancy, it had been in a cephalic presentation for most of the last trimester. No family history of hip problems was noted.

    On examination of the lower limbs, the infant’s legs were of equal length and the skin creases were symmetrical. Both hips abducted less than 60° and a “click”/“clunk” was felt on movement of the left hip. Neurological examination was normal and the neonate had no clinical signs of spinal dysraphism.

    Questions

    • 1 What is the likely diagnosis?

    • 2 How would you confirm the diagnosis?

    • 3 What treatment should be considered?

    Answers

    1 What is the likely diagnosis?

    Short answer

    The clinical signs are highly suspicious of bilateral hip dislocation (developmental dysplasia of the hip). The left hip “click”/“clunk” suggests a positive Ortolani test, in which case the hip would be reducible. The right hip, by contrast, was irreducible and much more concerning.

    Long answer

    The incidence of developmental dysplasia of the hip in the United Kingdom is 1.5 cases per 1000 people1; in 20% of cases (0.3 per 1000 people), both hips are affected. Bilateral dysplasia is rare and can pose a potentially perilous situation for the unwary examiner: the examination findings typical of unilateral hip dislocation—unequal leg length and an asymmetric appearance of the thigh skin folds—are absent. In bilateral hip dislocation, the skin folds are symmetrical and the Galeazzi test is negative (box).

    Tests for developmental dysplasia of the hip

    Galeazzi test: Child lies supine on an examination table with the hips fully flexed, the feet flat on the table, and the ankles touching the buttocks. The test is positive when the …

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