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Developmental Dislocation of the Hip: A Clinical Overview

Introduction

The most common musculoskeletal evaluation in the neonatal period and infancy is assessing the child's hips. Treatment of hip dislocation is most successful when begun early, making it imperative that all children undergo repeated, careful hip examinations beginning in infancy until walking age. Those physicians entrusted with the initial examination should have a clear understanding of the etiology, prevalence, and presentation of developmental dysplasia of the hip as well as the appropriate physical examination for this entity.

Historically, the term "congenital dislocation/dysplasia of the hip" (CDH) has been used. Reports illustrating cases of late diagnosis of hip abnormalities in patients who previously have had normal clinical and/or radiographic examinations as well as recognition of the wide spectrum of abnormalities from dislocation to dysplasia have led the orthopedic and pediatric communities to adopt the term developmental dislocation/dysplasia of the hip (DDH). This term now is preferred.

Definitions and Categorization

Hip dislocation can be categorized as "typical" or "teratologic." Teratologic dislocations are uncommon and usually are associated with neuromuscular abnormality, arthrogryposis, or myelomeningocele and typically are high, fixed dislocations. In contrast, "typical" DDH occurs in neurologically normal infants and encompasses a wide spectrum of deformity and presentation. It is important to recognize that previously stable hips may become unstable during infancy, and repeated examinations are needed until the child is of walking age.

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				H. Patel Preventive health care, 2001 update: screening and management of developmental dysplasia of the hip in newborns Can. Med. Assoc. J., June 1, 2001; 164(12): 1669 - 1677. [Abstract] [Full Text] [PDF]