Developmental Hip Dysplasia

6 week old F with h/o oligohydramnios, breech position, torticollis presents for well child check. Patient is her mother's first child and was large for gestational age. Clinical notes indicate concern for possible hip dysplasia during previous visits. Clunk felt with Ortolani and Barlow's maneuver on exam.

• Obtain hip ultrasound if not resolved by age 2 months

• Positive hip ultrasound: Refer to pediatric orthopedics for Pavlik harness fitting

• Parents reassured that condition is treatable

Notes

• Ortolani and Barlow maneuvers

  • Screening maneuvers rated “I” by USPSTF and AAFP

  • Only diagnostic in patients < 3 months old

  • A "click" is not a positive sign

  • A "clunk" indicates dislocation or relocation of femoral head

• Prognosis

  • 90% of cases observed in newborns resolve spontaneously

  • Refer at 2 months if issue does not resolve spontaneously