A 16-month-old girl walks with a waddling limp and limb length discrepancy. Examination shows limited abduction of the right hip and a positive Galeazzi sign. X-ray confirms a dislocated right hip. What is the most appropriate management?
- A Pavlik harness
- B Open reduction with pelvic osteotomy as the first procedure
- C Closed reduction under anaesthesia with arthrography followed by hip spica cast ✓
- D Observation until skeletal maturity
Correct answer: C. Closed reduction under anaesthesia with arthrography followed by hip spica cast
Explanation
Between roughly 12 and 24 months of age, a dislocated hip that has never been reduced is managed by attempted closed reduction under anaesthesia with arthrography, followed by spica immobilisation. The Pavlik harness fails once the child is walking because the hip cannot be reliably held reduced against muscle forces. Primary open reduction is reserved for failed closed reduction or when soft tissue interposition such as an inverted labrum blocks concentric reduction.
Reference: Tachdjian's Pediatric Orthopaedics, 5th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.