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  • Print publication year: 2014
  • Online publication date: June 2014

Case 83 - Developmental dysplasia of the hip

from Section 9 - Musculoskeletal imaging

Summary

Case 1

A one-month-old girl had a physical examination suggesting developmental dysplasia of the hip (DDH). A coronal sonographic image through the right hip in neutral position, performed at one month of age, demonstrated an abnormal alpha angle of 47 degrees and less than 50% coverage of the femoral head under the acetabular roof (Fig. 83.1a). Pelvic AP radiograph at three months of age demonstrated a steep right acetabular roof with asymmetrically delayed ossification of the right femoral head (Fig. 83.1b).

Case 2

A three-year-old girl with a chromosomal deletion syndrome presented with bilateral hip pain and difficulty with abduction. Pelvic AP radiograph demonstrated dysplastic acetabulae with bilateral femoral head dislocation, pseudoacetabula formation, and valgus deformity (Fig. 83.2a). Frog leg view demonstrated that the hips did not relocate with abduction (Fig. 83.2b). This appearance is typical of secondary neurogenic hip dislocation related to muscle imbalance and overactive hip adductors.

References
American Academy of Pediatrics. Clinical practice guideline: early detection of developmental dysplasia of the hip. Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip. Pediatrics 2000;105(4 Pt 1):896–905.
Dezateaux, C, Rosendahl, K. Developmental dysplasia of the hip. Lancet 2007;369(9572):1541–52.
Roposch, A, Graf, R, Wright, JG. Determining the reliability of the Graf classification for hip dysplasia. Clin Orthop Relat Res 2006;447:119–24.
Slovis, T, ed. Caffey’s Pediatric Diagnostic Imaging. 11th edn. Philadelphia: Mosby, 2007.
Wheeless, CR. Textbook of Orthopaedics, online edition. Original text by Wheeless CR. Last updated by Data Trace Staff on Dec 27, 2011. (accessed February 5, 2013).