Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Congenital dislocation of hip (CDH) ++ 756.9 Other and unspecified congenital anomalies of musculoskeletal system754.3 Congenital dislocation of hip754.30 Congenital dislocation of hip unilateral754.31 Congenital dislocation of hip bilateral754.32 Congenital subluxation of hip unilateral754.33 Congenital subluxation of hip bilateral754.35 Congenital dislocation of one hip with subluxation of other hip ++ Q68.8 Other specified congenital musculoskeletal deformities Q79.8 Other congenital malformations of musculoskeletal system Q79.9 Congenital malformation of musculoskeletal system, unspecified ++ 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Spinal Disorders14I: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Bony or Soft Tissue Surgery2 +++ Description ++ Group of bony abnormalities on hip jointFemoral head can be manually dislocated from the acetabulum easilyCongenital or acquired deformation/misalignment of the hip jointHip may be unstable, malformed, dislocated, dislocatable, or subluxated +++ Essentials of Diagnosis ++ Clinical diagnosis from a positive Ortolani sign or Barlow maneuverCongenitalIn utero posture of hip flexion and abduction contributes to disorderLink to relaxin hormoneTrait runs in families5AcquiredResult of swaddling, use of a cradle boardBreech birth +++ General Considerations ++ More common in infants with congenital muscular torticollis or metatarsus adductusOften associated with myelomeningoceleMay occur as a result of arthrogryposis +++ Demographics ++ Female-to-male ratio 5:1Approximately 1 in 1000 infantsMore common in first-born childrenThree times more common in left hip than right +++ Signs and Symptoms ++ Decreased hip abduction while in flexionAsymmetry of skin folds in superior, medial thigh or glutealsAbnormal gaitTrendelenburg gaitWaddle gaitEarly development of osteoarthritis +++ Possible Contributing Causes ++ Breech presentation or large fetal sizeAbnormal positioning in uteroInsufficient amniotic fluid (oligohydramnios)Hip extension and adduction positioning practiced in some cultures +++ Functional Implications ++ Hip movementStandingWalking, gaitSit-to-stand positional changes +++ Differential Diagnosis ++ Septic hipOsteoarthritisRheumatoid arthritisLumbosacral disorder +++ Imaging ++ Diagnostic ultrasound for infants under 6 months of ageRadiography for older children ++ To hospital for imaging: radiograph or diagnostic ultrasound of hipTo orthopedic surgeon for consultPavlik harness for infants worn 23 hours/day (except during bathing or physical therapy) from birth to 9 months (over 90% success rate)Frejka pillowHip abduction orthosis for ambulatory toddlers and childrenTractionClosed reduction, open reduction with or without osteotomy, hip spica cast ++ Decreased hip abduction on affected sidePossible developmental delay due to Pavlik harness Gait abnormality in toddlers or older childrenMay have decreased active and passive ROM in hip ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.