Developmental Dysplasia of the Hip (ReelDx): The Daily PANCE Blueprint
A 6-month-year-old has a palpable clunk when you apply downward pressure while the hip is flexed and adducted. What sign is this?
A. Galeazzi sign
B. Ortolani sign
C. Barlow sign
D. Trendelenburg sign
E. Mennell’s sign
Answer and topic summary
The answer is C. Barlow sign
Developmental dysplasia of the hip (DDH) is defined by subluxation/dislocation of the femoral head, acetabular dysplasia, or hip instability. The top two risk factors are (1) family history and (2) breech presentation. Clinical features depend on the age of the patient, but you may see a positive Ortolani or Barlow sign, unequal thigh folds, inability to ABduct the hip, prominent Galeazzi sign, hip pain, and leg length discrepancy. Hip ultrasound is the imaging of the choice when <4 months, and a pelvic x-ray is preferred when >4 months. Treatment is Pavlik harness; if the patient failed that or is already at an older age, then they will need closed reduction or possibly open reduction (+/- pelvic/femoral osteotomy).
Barlow sign: palpable clunk when the hip is flexed and adducted (while applying downward pressure)
Ortolani sign: palpable clunk when the hip is flexed and ABducted (while applying upward pressure)
Galeazzi sign: unequal height of knees (when a child is supine with both hips/knees flexed)
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Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ ⇒
