Developmental dysplasia of the hip — branching viva

Opening question

A five-week-old girl born in the breech position has a clunk on the left Ortolani test and a Graf type III hip on ultrasound. Describe your Ortolani and Barlow examination, state the Graf alpha-angle thresholds, and give your management. [1] [2]

Branch 1 — the three-week reduction check

The ultrasound at three weeks shows the femoral head is still not reduced in the Pavlik harness. What is the risk of continuing the harness, and what is your next step? [3] [1]

Branch 2 — the clunk versus the click

The examiner asks: how do you distinguish a true Ortolani clunk from a benign soft-tissue click, and how does the distinction change your management of a low-risk baby? [2] [1]

Branch 3 — the late-presenting child

The examiner changes the scenario. A two-year-old girl walks in with a painless left-sided limp and a short left leg, having had normal newborn checks. What is the likely diagnosis, why was it missed, and what investigation makes the diagnosis? [4] [2]

Closing — coordination and safety

In one sentence, what is the principle of managing developmental dysplasia of the hip across the age span, and why does the general paediatrician sit at the centre of a plan that runs from the newborn clunk to the orthopaedic reduction? [1] [3]