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Condition/Disorder Synonyms

  • Congenital dislocation of hip (CDH)

ICD-9-CM Codes

  • 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

ICD-10-CM Codes

  • Q68.8 Other specified congenital musculoskeletal deformities

  • Q79.8 Other congenital malformations of musculoskeletal system

  • Q79.9 Congenital malformation of musculoskeletal system, unspecified

Preferred Practice Patterns

Key Features

Description

  • 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

Essentials of Diagnosis

  • 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

General Considerations

  • More common in infants with congenital muscular torticollis or metatarsus adductus

  • Often associated with myelomeningocele

  • May occur as a result of arthrogryposis

Demographics

  • 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

Clinical Findings

Signs and Symptoms

  • 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

Possible Contributing Causes

  • Breech presentation or large fetal size

  • Abnormal positioning in utero

  • Insufficient amniotic fluid (oligohydramnios)

  • Hip extension and adduction positioning practiced in some cultures

Functional Implications

  • Hip movement

  • Standing

  • Walking, gait

  • Sit-to-stand positional changes

Differential Diagnosis

  • Septic hip

  • Osteoarthritis

  • Rheumatoid arthritis

  • Lumbosacral disorder

Means of Confirmation or Diagnosis

Imaging

  • Diagnostic ultrasound for infants under 6 months of age

  • Radiography for older children

Referrals/Admittance

  • 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 ...

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