Common Pediatric MSK Concerns


Plain radiograph demonstrating dislocated left hip in infant
Note the delayed ossification of the left femoral head and
the formation of a 'false acetabulum' in the left iliac wing.
Image source: L. Davidson

In societies with modern healthcare and established screening programs, children with Developmental dysplasia of the hip (DDH) are usually diagnosed in infancy and therefore they do not present with a limp. Nevertheless, it is possible for hip dysplasia to be difficult to diagnose in the newborn and present in the walking age child with a gait abnormality.

DDH is actually a spectrum ranging from frank dislocation (as illustrated in the left hip on the x-ray seen above), to dislocatability to subluxation of one or both hips. There is a definite genetic tendency towards DDH and therefore children with a positive family history of DDH should be carefully examined for this condition. Other important risk factors include: female, first born, breech position prenatally, ligamentous laxity.

All newborns and babies in the first year of life are regularly screened by physical examination using the Barlow and Ortolani maneuvers. Make sure that you are logged in to MedTech in order to see and click on the link above with videos of Barlow and Ortolani tests (Queen's Faculty of Health Sciences community members only).

In the hands of an experienced operator, ultrasound is a useful test to visualize acetabular development and femoral head position in children 8 months of age or younger. It is used for diagnosis and screening of babies in high risk categories.

Normal hip ultrasound (left)
Abnormal ultrasound (right) - dysplastic acetabulum, subluxation hip
Image source: L. Davidson