Hip Exam

Introduce yourself
Explain that you are going to examine child’s hips
Wash hands

Inspection

  • Exposure
  • Position of legs
  • Equal bilateral movement of legs
  • Skin folds (hold child up, place prone) – gluteal folds
  • Sacral dimple
  • Bend knees up and assess knee height (Galeazzi sign); leg length
  • Muscle mass, atrophy

Palpation

  • Palpate SI joint
  • Barlow’s dislocation: stabilize pelvis with one hand, apply posterior and adduction force to leg (hand on knee with first finger on greater trochanter)
  • Ortolani’s relocation: stabilize pelvis with one hand, apply abduction force to hip with hand in same position
  • Feel for CLUNKs
  • Telescoping test: with hips and knees flexed pull leg anteriorly and push posteriorly feeling for any instability

Dress child
Thank examiner
Wash hands

On the exam one of the legs is turned inwards and the folds do not quite meet up… the child has DDH.

Developmental dysplasia of the hip is an abnormal formation of the hip joint in which the ball at the top of the thighbone (femoral head) is not stable in the socket (acetabulum).

Risk Factors for Developmental Dysplasia of the Hip

  • Family history
  • First born
  • Female
  • Frank breech
  • Oligohydramnios

Plan

  • Hip ultrasound
  • Pavlik harness
  • Closed reduction and spica casting

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