A newborn is found to have bilateral hip instability (positive Ortolani and Barlow tests) at birth. Ultrasound confirms developmental dysplasia of the hip (DDH) bilaterally in a 3-week-old infant. The first-line treatment is:
- A Pavlik harness for 6–12 weeks ✓
- B Immediate open reduction and spica casting
- C Closed reduction under general anaesthesia and spica casting
- D Observation until 6 months before treating
Explanation
The Pavlik harness is the gold standard first-line treatment for DDH in infants under 6 months of age. It maintains the hip in flexion (90–100°) and abduction (40–60°), promoting spontaneous reduction and normal acetabular development. Success rate is ~85–90% for Ortolani-positive (reducible) hips. Failure of Pavlik harness, or presentation after 6 months, leads to closed reduction under GA and spica casting, or eventually open reduction. Spontaneous resolution occurs in ~80% of clinically unstable hips within the first 2–3 weeks — so immediate surgical intervention is not warranted initially. Delaying treatment to 6 months is inappropriate for confirmed DDH.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.