Monday, August 31, 2009

Hip Hop

A healthy six month old infant comes for a well child check. She had a breech presentation at birth but was delivered vaginally without complication. Otherwise, she is up to date on her vaccinations and sees you regularly. The infant is calm, not crying, and supine on the examining table with hips flexed to 90 degrees in neutral rotation. You grasp her right thigh and gently adduct the hip with posteriorly directed pressure. You note posterior sliding and a palpable "clunk." You then abduct the hip and lift anteriorly and feel another clunk. Here's an X-ray:



Challenge: What's your diagnosis?

Image is in the public domain.

3 comments:

shabnam said...

CDH...?

Stephanie said...

hip dysplasia

Craig Chen said...

hip dysplasia :)
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Hip Hop

This is developmental dysplasia of the hip, which can lead to instability or dislocatability of the hip joint and abnormal shape of the acetabulum. The Ortolani and Barlow maneuvers are described. Hip exam should be done at every visit until the patient is walking normally.

Sources: UpToDate; Wikipedia.