Examination After Age 3 Months

Limited Abduction

In this older age group, the most common finding is limited abduction of the hip. After the age of three months hip dislocation may be fixed and may not be detected by the Ortolani or Barlow methods that are used to examine newborn infants. For this reason the “hip click” described by Ortolani is rarely meaningful after the age of 6-8 weeks. Careful examination with the pelvis level is necessary. Bilateral hip dislocations may be more difficult to identify because they are symmetrically tight. The mother may indicate that it is difficult to apply diapers when both hips are dislocated or she may notice a difference when only one hip is dislocated.The Left hip of the six-month old child shown above is dislocated. Note limited abduction

Limb Length Difference

Difference in thigh lengths may be caused by unilateral hip dislocation. This is detected by the Allis or Galeazzi test. In this test, the hips are flexed and the length of the thighs are compared to see if the knee heights are equal. This is difficult to determine in infants because the pelvis must be perfectly level.

Asymmetrical Buttock Creases

Asymmetrical gluteal creases may be a sign of unilateral hip dysplasia. Thigh folds that are asymmetrical rarely indicate hip dysplasia unless they are associated with uneven gluteal creases.
                                 
Asymmetrical thigh folds are usually OK.                          Note high gluteal and thigh folds with left dislocated hip

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