X-rays for DDH, developmental dysplasia of the hip

[bdigParticipant]

I have been looking at several different guidelines RE: DDH and CT after age 4 months.  In practice, I have never seen a CT done. Here’s the medscape article: http://emedicine.medscape.com/article/408225-overview#showall  and http://emedicine.medscape.com/article/1248135-workup#a0720.

So, the wording on the DDH question in the Q&A book (#8 on p. 14 online) should be x-ray instead of CT. Right?

[ashishMember]

You’r right. And thanks so much for the references. It really helps when I get those!

I also reviewed the AAP guidelines in a Pediatrics article. No mention of CT. Just radiographs. – http://pediatrics.aappublications.org/content/105/4/896.full.pdf+html

Here’s the revised section from the book. I’ve also modified the Q&A book.

DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)

Infants with developmental dysplasia of the hip (DDH) may be noted to have a leg-length discrepancy or extra creases at the thigh. Girls and breech deliveries pose a higher risk. Workup varies by age and family history. Treatment requires a Pavlik harness.

* CRITERIA FOR A CHILD LESS THAN 4 MONTHS:

• ASYMPTOMATIC: If there is a history of DDH in a first degree relative, get an ultrasound!
• SYMPTOMATIC: If there are signs of developmental dysplasia of the hip (DDH) on exam, get an ultrasound!

* CRITERIA FOR A CHILD GREATER THAN 4 MONTHS:

• ASYMPTOMATIC: If there is no family history, then no workup is needed. If there is a history of DDH in a first degree relative and an evaluation was never done, then since the child is now greater than 4 months of age, plain radiographs (hip x-rays) would be indicated. Plain x-rays are more reliable than an ultrasound at this age (femoral head ossification centers are more developed).
• SYMPTOMATIC: For any child greater than 4 months of age that has signs of developmental dysplasia of the hip (DDH) on examination (regardless of family history), they need to be worked up. Therefore, get plain radiographs (not an ultrasound) since they’re more reliable at this age.

* PEARLS:  The age cutoff for ultrasounds is 4 months, NOT 6. When it comes to the Barlow and Ortolani signs, EITHER of them being positive should prompt a workup!

* IMAGE: http://bit.ly/qHTScy

* IMAGE: http://bit.ly/qTQrK8

 

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