Explain a positive newborn hip examination to a family — OSCE

Candidate brief

You have eight minutes to counsel the parents of a five-week-old breech-born girl who has been diagnosed with developmental dysplasia of the hip after a clunk was felt on the Ortolani test and confirmed by a Graf type III ultrasound. Use a structured, honest, empathic approach that explains the condition in plain language, addresses the parents' fears about the harness and surgery, and builds a shared plan around the Pavlik harness and the three-week check. [1] [2]

Key teaching and communication objectives

Acknowledge and validate the parents' anxiety before delivering information, and allow silence. Explain in plain language that the socket of the hip has not grown deep enough to hold the ball of the joint firmly, that the clunk the doctor felt was the ball slipping in and out of the shallow socket, and that this is a problem of development rather than an injury or a break. Address the breech position directly — it is a known risk factor because the hips are held flexed in the womb, and finding it now rather than later is a good thing. [2]

Explain the Pavlik harness clearly and reassuringly. Describe it as a soft splint of straps that holds the baby's hips bent and gently apart so that the ball points into the socket and the socket grows deeper around it, worn for twenty-three hours a day for a few weeks. Reassure them that the harness does not hurt the baby, that they can still cuddle, feed, and change the nappy with it on, and that most hips treated this way at this age recover fully without surgery. [3]

Explain the three-week check honestly and without minimising the small risk. Tell them that an ultrasound at three weeks confirms whether the ball has moved into the socket, and that if it has not, the harness is stopped so it does not press on the growing bone and cause a problem with the blood supply to the joint. Frame the check as a safeguard that keeps the treatment safe, and give the realistic hope that most hips are reduced by then and go on to mature normally. [1] [3]

Close with a shared plan and a clear next step. Name the orthopaedic team that will fit and review the harness, give a realistic timeline for the ultrasound and the follow-up, explain the hip-safe swaddling and handling while the harness is on, and invite questions. Confirm understanding with a teach-back, and arrange a follow-up conversation after the three-week ultrasound so the family is never left waiting without information. [3] [2]