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  • Congenital dislocation of hip (CDH)

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  • 756.9 Other and unspecified congenital anomalies of musculoskeletal system
  • 754.3 Congenital dislocation of hip
  • 754.30 Congenital dislocation of hip unilateral
  • 754.31 Congenital dislocation of hip bilateral
  • 754.32 Congenital subluxation of hip unilateral
  • 754.33 Congenital subluxation of hip bilateral
  • 754.35 Congenital dislocation of one hip with subluxation of other hip

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  • Q68.8 Other specified congenital musculoskeletal deformities
  • Q79.8 Other congenital malformations of musculoskeletal system
  • Q79.9 Congenital malformation of musculoskeletal system, unspecified

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Description

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  • Group of bony abnormalities on hip joint
  • Femoral head can be manually dislocated from the acetabulum easily
  • Congenital or acquired deformation/misalignment of the hip joint
  • Hip may be unstable, malformed, dislocated, dislocatable, or subluxated

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Essentials of Diagnosis

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  • Clinical diagnosis from a positive Ortolani sign or Barlow maneuver
  • Congenital
    • In utero posture of hip flexion and abduction contributes to disorder
    • Link to relaxin hormone
    • Trait runs in families5
  • Acquired
    • Result of swaddling, use of a cradle board
    • Breech birth

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General Considerations

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Demographics

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  • Female-to-male ratio 5:1
  • Approximately 1 in 1000 infants
  • More common in first-born children
  • Three times more common in left hip than right

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Signs and Symptoms

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  • Decreased hip abduction while in flexion
  • Asymmetry of skin folds in superior, medial thigh or gluteals
  • Abnormal gait
  • Trendelenburg gait
  • Waddle gait
  • Early development of osteoarthritis

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Possible Contributing Causes

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  • Breech presentation or large fetal size
  • Abnormal positioning in utero
  • Insufficient amniotic fluid (oligohydramnios)
  • Hip extension and adduction positioning practiced in some cultures

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Functional Implications

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  • Hip movement
  • Standing
  • Walking, gait
  • Sit-to-stand positional changes

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Differential Diagnosis

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Imaging

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  • To hospital for imaging: radiograph or diagnostic ultrasound of hip
  • To orthopedic surgeon for consult
    • Pavlik harness for infants worn 23 hours/day (except during bathing or physical therapy) from birth to 9 months (over 90% success rate)
    • Frejka pillow
    • Hip abduction orthosis for ambulatory toddlers and children
    • Traction
    • Closed reduction, open reduction with or without osteotomy, hip spica cast

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  • Decreased hip abduction on affected side
  • Possible developmental delay due to Pavlik harness
  • Gait abnormality in toddlers or older children
  • May have decreased active and passive ROM in hip and knee from hip spica casting following open or ...

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