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Early Detection of Developmental Dysplasia of the Hip. Pediatrics (2000); 105:896-905.
This article is a published clinical practice guideline by the Committee on Quality Improvement and the Subcommittee on Developmental Dysplasia of the Hip of the American Academy of Pediatrics. It presents an algorithm for recommended screening for this disorder. Highlights include:
All newborns should be screened by physical exam by a properly trained healthcare provider (eg physician, PNP, PA, or physical therapist). The Screening exam should consist of both the Ortolani and Barlow maneuver. The screening exam should also be performed for newborns after discharge from the NICU.
If the Newborn exam in unequivocally positive (a "clunk"), orthopedic referral is indicated. Since most abnormal hip exams (clicks and clunks) will resolve by 2 weeks, orthopedic consultation and possible treatment are recommended at that time. Xrays or Ultrasound exams of hips are NOT recommended, as they do not influence treatment decisions. Triple diapers are NOT recommended, as data is lacking on effectiveness, and there is concern about delaying more appropriate therapy.
If the newborn exam is equivocally positive (soft click or asymetry), then a follow up examination by the pediatrician in 2 weeks is recommended. Again, xrays, ultrasounds or triple diapers are not recommended in the newborn period. If the 2-week exam is positive, then refer to orthopedics; if equivocal, consider orthopedic referral or request ultrasound evaluation at 3-4 weeks; if negative, follow at regularly scheduled well-baby exams.
Special Higher Risk Categories:
Girls: (19/1000) - No change in algorithm.
Family History and Boys (9.4 / 1000). No change in algorithm.
Family History and Girls (44 / 1000). Consider ultrasound exam at 6 weeks or pelvic xray at 4 months, even if exam is normal.
Breech Presentation and Boy (26/1000). Consider pelvic xray at 6 months of age to look for acetabular dysplasia, even if exam is normal.
Breech Presentation and Girl (120/1000). Ultrasound exam at 6 weeks of age or xray exam at 4 months of age is recommended, even if exam is normal.
Comment. Be aware that this practice guideline probably reflects significant changes from our current clinical practice. Particularly, 1) radiographic or ultrasound hip evaluations are not indicated in the immediate newborn period; and 2) certain high-risk groups of patients who deserve radiographic or ultrasound evaluations for hip dysplasia even if their clinical exams are normal.
Andrew B. Kairalla MD