Module 1, General Orthopaedist Level

A four year old female with Down's Syndrome presented to the emergency room with the left hip flexed, adducted and internally rotated. This occurred after a fall from a tricycle. The mother previously reported clicking in the left hip which had been present since age 2.

Question 1A

This is most likely a dislocated hip in a child with hip instability due to Down's syndrome.

Question 1B

Because of generalized osteoporosis this probably includes a fracture even if a dislocation is present.

Question 1C

An xray is obtained which shows a dislocated hip. This will require a general anesthesia for a reduction to be obtained.

Question 1D

If this is the first episode of a dislocation the child should be placed in a hip spica cast for six weeks.

Question 1E

The natural history of a dislocation of the hip in a child with Downs is similar to an age matched normal peer.