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Old 06-17-2011
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Kids A new born with an audible hip clunk!

A 5-day-old female neonate was reviewed for newborn screening. Flexion and adduction of the hip results in the femoral head dislocating across the acetabulum. Flexion and abduction produce an audible clunk. What is the most appropriate next step in the management of this patient?

a. Pavlik harness
b. Surgical closed reduction
c. Triple diapers
d. Spica cast
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Old 06-17-2011
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Answer A. Congenital dislocation of hip common in first born female . Detected with Ortolani maneuver
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Old 06-17-2011
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yes, kaplan pediatrics says pavlik harness is the 1st step in CDH. (A)
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Old 06-18-2011
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A -pavlik harness if age< 6 months

and spica cast if age (6month- 15 month)
open reduction and then spica cast if age (15 month -24 month )
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Old 06-18-2011
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Just a little more info...

risk factors: caucasian, female, first-born, breech birth, family history

It's not likely to be test on the boards, but a simple way to remember Barlow from Ortolani test maneuvers is:

Barlow - Bring together
Ortolani - Open

Also, something that they do test on is which imaging test is most appropriate:

-US if < 4m (since femoral head and acetabulum aren't ossified)
-radiographs > 4 mo
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Old 06-23-2011
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Default Pavlik Harness!

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