🦴 Section 719.1 · Developmental Dysplasia of the Hip (DDH)

Nelson Textbook of Pediatrics 22nd Edition | DDH spectrum: acetabular dysplasia → subluxation → dislocation. Barlow test (dislocatable), Ortolani test (reducible clunk). Risk factors: female, breech, family history, firstborn, left hip. Ultrasound (Graf) is gold standard for infants <6 months. Treatment: Pavlik harness (<6 months), closed reduction + spica cast (6-18 months), open reduction + osteotomy (>18 months or failed closed reduction).

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📋 30 Clinical Scenarios — Developmental Dysplasia of the Hip

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🩺 Clinical Recognition: DDH

Select a presentation to review diagnostic clues and management per Nelson 719.1.

📋 Stepwise Management of DDH

🔑 Key Principles — Nelson Section 719.1
• Screening: All newborns — Barlow (dislocatable) and Ortolani (reducible clunk) maneuvers.
• Risk factors: Breech presentation, female sex, positive family history, firstborn, left hip, oligohydramnios, swaddling with hips extended.
• Imaging: Ultrasound (Graf) for infants <6 months (alpha angle >60° normal). Radiographs after 4-6 months (acetabular index, Shenton's line, Perkins line).
• Treatment by age: <6 months → Pavlik harness. 6-18 months → closed reduction + spica cast. >18 months or failed closed reduction → open reduction + femoral/pelvic osteotomy.
• Complication: Avascular necrosis of femoral head (most important — avoid forced abduction).

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: Developmental Dysplasia of the Hip (Nelson 719.1)