This maneuver should be done gently as forceful adduction can cause instability. You will feel the clunk or jerk if the hip can be dislocated. īarlow maneuver: in the same above position, while applying posterior force to trochanter (AAP recommends against posterior force), adduct the hip. If the hip dislocated, one would feel a jerk or clunk. 'Hip clicks' are clinically insignificant without instability. The hip is held in the way the thumb on the inner aspect and index and ring finger on the greater trochanter. While applying anterior force on the greater trochanter, gently abduct the hip. The infant should be calm, and clothes and diapers should be removed. Ortolani maneuver: Infant in the supine position, hip flexed at 90 degrees and in neutral rotation. Hip instability/dislocation can be identified by Barlow and Ortolani manoeuver. Newborn: Clinical examination is crucial in the identification of DDH, especially babies with risk factors. Ĭlinical features vary for mild hip instability, limited abduction in the infant, asymmetric gait in the toddler, hip pain in adolescence, and osteoarthritis in the adult.Īmerican Academy of Pediatrics (AAP), the American Academy of Orthopaedic Surgeons(AAOS), the Pediatric Orthopaedic Society of North America(POSN), and the Canadian Task Force recommends screening newborn for DDH. Maligned contact for a prolonged period leads to chronic changes like hypertrophy of capsule, ligament teres, the formation of thickened acetabular edge (neolimbus), which further prevents the contact, and prevents the relocation of the femoral head. Acetabulum continues to grow up to age 5. Swaddling in extreme position (extended hip, adducted, immobile) resulting in maligned contact between the acetabulum and femur prevents proper development of the hip. But in utero femoral head growth is faster than acetabulum, which results in under coverage of the femoral head, so any disturbance in the contact will lead to abnormal development. By 11th-week, the hip joint is recognizable. The middle layer undergoes autolysis to form joint space, synovial membrane, and ligamentum teres.

Proximally acetabulum is formed as a shallow depression at 65 degrees this later must deepen to 180 degrees, distally the femoral head and articular cartilage. In the 7th week, Interzone differentiates the sides of the hip joint. Blastemal cells form trochanteric projection. At six weeks of life, cartilage develops into femur diaphysis, precartilage into the future femoral head, which can’t be differentiated from the acetabulum. Lower limb buds develop around four weeks, chondroblasts aggregate to form the future bones of the hip joint.

Any interference with proper contact between these two in utero or infancy leads to DDH. The formation of the hip joint is highly dependent on the dynamic relationship between femur and acetabulum.

Normal hip xray female human