Hip Dysplasia and Dislocation in Infants and Young Children (DDH)

Developmental dysplasia of the hip (DDH) means the ball of a baby's thigh bone is not held firmly in its socket. It ranges from a shallow socket, through a hip that can be pushed out, to a hip that is fully dislocated. It is not caused by injury and is not painful in babies.

Found in the first months, it is usually corrected with a soft harness and the hip develops normally. Found after walking age, it needs anaesthetic, plaster and often surgery, and the risk of early arthritis in adult life is higher. Early detection is therefore the whole point.

Symptome

• A clunk felt by the doctor during newborn hip examination
• One leg that opens out less than the other during nappy changes
• Uneven thigh or buttock skin creases
• One leg appearing shorter
• In walkers, a painless limp, toe walking on one side or a waddling gait if both hips are out
• Often no signs at all, which is why screening exists

Ursachen und Risikofaktoren

Around birth the hip socket is shallow and soft, and ligaments are loose under the influence of maternal hormones. Anything that holds the hips straight and together encourages the ball to slide out. Known risk factors are breech position in late pregnancy, a parent or sibling with DDH, being a girl, a first baby, low amniotic fluid, and tight swaddling with the legs bound straight. The left hip is affected most often. Carrying babies with hips bent and spread, as in a sling facing the parent, is protective.

Wie es diagnostiziert wird

• Newborn and 6 week examination: Ortolani and Barlow manoeuvres and a check of hip abduction.
• Hip ultrasound: The key test up to about 4 to 6 months, before the ball turns to bone; graded by the Graf method. Offered to all babies in some countries and to those with risk factors in others.
• Pelvic X-ray: Used from about 4 to 6 months of age onwards.
• Arthrogram under anaesthetic: Dye in the joint shows whether the hip seats properly during closed reduction.
• MRI or CT after plaster: Confirms the hip is in place inside the spica cast.

Behandlungsmöglichkeiten

• Observation with repeat ultrasound: For mild immaturity in the first weeks, which often resolves.
• Pavlik harness: Soft straps holding the hips bent and apart, worn full time for about 6 to 12 weeks under 6 months of age; works in roughly 9 of 10 suitable hips.
• Abduction brace: A firmer alternative or follow-on to the harness.
• Closed reduction and spica cast: From about 6 to 18 months: the hip is guided in under anaesthetic, often with a small tendon release, and held in a body cast for about 3 months.
• Open reduction: Surgery to clear the socket and place the hip when closed reduction fails or in older infants.
• Pelvic or femoral osteotomy: Bone reshaping, usually after 18 months to 2 years, to deepen coverage of the ball.

Wenn es dringend ist

DDH is not an emergency, but it is time sensitive: ask for prompt referral rather than waiting. A child in a harness who stops kicking one leg needs review within a day for possible femoral nerve palsy. A child in a spica cast with fever, a foul smell, or blue, cold or swollen toes needs same day local care. A child with a limp plus fever and refusal to bear weight may have a hip infection, which is an emergency.

Reisen nach Türkiye zur Behandlung

Harness treatment needs checks and ultrasound every 1 to 2 weeks for 2 to 3 months, so it belongs close to home. Travel can be reasonable for a specialist opinion, for a late diagnosed dislocation needing open reduction or osteotomy, or for residual dysplasia in an older child. Plan for a stay of 2 to 3 weeks, check airline rules for a child in a spica cast, and secure a local paediatric orthopaedic team for cast changes and X-ray follow-up until growth is complete.

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