DEVELOPMENTAL

DYSPLASIA OF THE HIPS

Shelby Rhoda
DMS 497
Fall 2016
 CASE HISTORY
5 mo Caucasian female
Pediatric hip ultrasound ordered to follow up diagnosis of
developmental dysplasia of the hips after being placed in
Pavlik harness for 6 weeks
Born at 38w 3d by spontaneous vaginal delivery weighing
6lb 3oz
Symptoms: persistent hip clicks
Labs: none available
Elevated circulating maternal estrogen creates ligamentous laxity
 CASE HISTORY

Previous ultrasound 6 weeks prior for hip clicks

Superolateral dislocation of the right femoral
head with no contact with the acetabulum
Lateral subluxation of the left femoral head with
partial coverage by the acetabulum
Patient placed in Pavlik harness for 6 weeks
 SCANNING TECHNIQUES
Dynamic Technique:
the Barlow maneuver with the patient laying supine and
using a linear transducer to have a lateral view of the hip
Coronal and transverse images are taken in flexion and
extension positions
should show sonographically a femoral head remaining in
the acetabulum with the flexion and extension movements

Acetabulum is composed of both bone and

cartilage
Ossification centers of the ilium, ischium, and
 SONOGRAPHIC FINDINGS

Figure 1: Labelled anatomy on a normal ultrasound of the Figure 2: Animation of normal hip anatomy.
Pediatric femur fixed within the acetabulum
 SONOGRAPHIC FINDINGS
LAT

SUP INF

MED
igure 3: Coronal image of the right hip showing
ateral and superior displacement of the femur. Figure 4: Transverse image of the laterally displaced
he red star indicates the correct location of the femoral
femoral head.
head.
 SONOGRAPHIC FINDINGS

Figure 5: Coronal image of the left hip showingFigure 6: Coronal image of the left hip showing lateral
lateral displacement of the femoral head. Subluxation of the femoral head.
 DIAGNOSIS

Superolateral dislocation of the right femoral

head
Lateral subluxation of the left femoral head
Unchanged from previous ultrasound
Dislocation: femoral head is displaced laterally,
posteriorly, and superiorly to the acetabulum
with no contact or coverage by the acetabulum
Subluxation: the femoral head is positioned
 DIAGNOSIS

Incidence: occurs in 1.5 for every 1000

infants
More common in females with 4:1 ratio
After ossification is complete MRI is used
to diagnose DDH
 DIFFERENTIAL DIAGNOSIS
Differential:
Hip Effusion: build-up of fluid around the joint
capsule, the anterior recess of the joint becomes
distended with at least 2mm of increased
thickness of the abnormal joint
Sonographically: bulging joint capsule is seen
with debris between the femoral epiphysis and
the acetabular cup
Rare finding before the first year of life because
the femoral neck has not developed and the
capsule is small
Treatment: Arthrocentesis
 FOLLOW-UP

Patient placed in Pavlik harness for 6 weeks

a restraint device that maintains the hip in flexion and
abduction
US used to document progress every 6 weeks
Placement in the harness continues until ligaments are
stable
 CONCLUSION
5 mo presents for follow-up of Pavlik harness placement
Presents with hip clicks
Subluxation of the left hip and dislocation of the right hip

Treatment with Pavlik harness will continue for 6

more weeks
Pitfall: not having knowledge on the subject
Take away message:
Seek help with doctor or radiologist when not confident with
an exam
 REFERENCES
Harcke, Theodore. Grissom, Leslie. Performing Dynamic
Sonogrpahy of the Infant Hip. Wilmington, DE: Department of
Medical Imaging; 1990.
Chung, Ellen. Coley, Brian. Pediatric Sonography. First edition.
Retrieved from: http://ovidsp.tx.ovid.com/sp-3.22.1b/ovidweb.cgi?
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.sh.6267_1479088521_48%7c2%7csl_10
Carol Rumack, Stephanie Wilson, J. Charboneau, Deborah Levine.
Diagnostic Ultrasound. Fourth edition. Philadelphia, PA: Mosby,
Inc.; 2011.