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Review Question - QID 6113

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QID 6113 (Type "6113" in App Search)
A newborn girl with an isolated unilateral dislocatable hip is placed in a Pavlik harness with the hips flexed 100 degrees and at resting abduction. Figure 23 shows an ultrasound obtained 2 weeks later. What is the next step in management?
  • A

Reposition the harness to hold the hips in 70 degrees of abduction

20%

149/753

Closed reduction and arthrography under anesthesia

7%

53/753

Open reduction and a spica cast

1%

11/753

Continued harness treatment in the current position

69%

516/753

Spica cast

2%

14/753

  • A

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The infant has a well-positioned hip in the Pavlik harness and treatment should be continued in the current position. The success rate is over 90% with the use of this device for a dislocatable hip. Ultrasound is a useful tool to confirm appropriate positioning of the cartilaginous femoral head during treatment. If the femoral head is not reduced after 2 to 3 weeks in the harness, this mode of treatment should be abandoned. Forceful extreme abduction can cause osteonecrosis of the femoral epiphysis and should be avoided. Closed reduction, arthrography, and spica casting are indicated if the hip cannot be maintained in a reduced position with the harness.

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