Module 1, Pediatric Orthopaedist Level

This is a 2.5 year old female with Down's Syndrome whose mother noticed few episodes of "popping in and out" in the right hip with adduction and flexion. These episodes were painless and patient had no limp. She is otherwise healthy and has just started walking. Other significant medical history includes a persistent minor atrioseptal defect and a recurrent otitis media. The physical exam revealed a full range of motion, with instability of the hip. The hip was dislocated with extreme adduction/flexion and easily reduced.

Question 1A

The most appropriate treatment at this age is to place the child in full time abduction orthosis.

Question 1B

The cause of the dislocation is related to the same reasons of soft tissue laxity which cause neck instability and may continue to develop even into adulthood.

Question 1C

Surgical reconstruction can be accomplished with hip capsular plication followed by immobilization.

Question 1D

Total hip replacement is a good option in young adulthood for this child if the hip can not be stabilized completely during childhood.

Question 1E

Surgical treatment in childhood has an expectation of providing this child with a normal hip 90 percent of the time.