Module 11, Pediatric Orthopaedist Level

1,2

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 (image 1). He was placed in a Pavlik harness but this treatment was unsuccessful. Closed reduction was performed, but the hip redislocated. This child then had an open reduction with casting for three months(image 2, x-ray after cast removal).

Question 11A

An attempt should now be made to gain range of motion in the hip.

Question 11B

At some point in the near future a repeat open reduction must be performed to reduce this hip.

Question 11C

An arthrogram at two years of age show irregular ossification of the femoral head and dysplastic acetabulum, but the hip coverage is acceptable even in adduction.

Question 11D

The AVN will make a substantial limb length problem at maturity.

Question 11E

At age six this boy was diagnosed with Charcot Marie Tooth disease which adds to the risk for his dysplastic acetabulum.