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Appropriate Use Criteria

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Appropriate Use Criteria 2020-01-08T18:06:15+00:00

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GUIDELINE

APPROPRIATE USE CRITERIA: DDH: MANAGEMENT FOR ORTHOPAEDIC SPECIALISTS (2022)

INDICATION PROFILE

Age

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Breech presentation is felt to be a particularly strong risk factor for DDH even in the face of a normal physical exam. Recommendation is for screening ultrasound at 6 weeks and a single AP pelvis radiograph at 6 months.

Birth – 4 weeks
4 weeks – 4 months
4 months – 6 months

Risk Factors

Risk factor(s) present (breech presentation, family history, history of improper swaddling, or history of clinical instability)
No risk factors present (breech presentation, family history, history of improper swaddling, or history of clinical instability)

Physical Exam Findings

Normal Physical Exam Findings
Hip Instability – Dislocated, Reducible
Hip Instability – Dislocated, Irreducible
Hip Instability – Subluxable or Dislocatable
Limited abduction
Limb length discrepancy

Ultrasound

Normal (≥ 60 degrees and > 45% femoral head coverage)
Borderline (50-59 degrees or 35-45% femoral head coverage) – Age should be considered
Dysplastic (< 50 degrees or <35% femoral coverage)
No ultrasound performed

IHDI AP Pelvis (“Plain”) Radiograph Grade

Grade I – Reduced, Normal Acetabulum
Grade I – Reduced, Acetabular Dysplasia
Grade II - Subluxated
Grade III/IV – Dislocated
No radiograph performed

PROCEDURE RECOMMENDATIONS

Treatment recommendations are not available for this patient scenario.

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