Module 11, General Orthopaedist Level

A 6 week old boy was in breech position and delivered by C-section. He is the first child for this 38 year old mother. At 6 weeks of age a dislocated hip was noted. He was placed in a Pavlik harness but this treatment was unsuccessful. Closed reduction was performed, but the hip redislocated.

Question 11A

The Pavlik Harness should be left on for a maximum of 4 weeks and if the hip is not reduced a different method needs to be considered.

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Question 11B

If the harness fails to reduce the hip, doing a closed reduction under anesthesia with spica cast immobilization is the next treatment to try.

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Question 11C

After the hip dislocates in the cast the child must be returned to the operating room and a repeat closed reduction performed.

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Question 11D

The hip probably dislocated because there was not enough hip abduction in the cast .

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Question 11E

A Computerized Tomographic scan is the best method to be certain that a closed reduced hip is in fact reduced.

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