A 3-week-old infant is diagnosed with DDH (Graf type IV) on ultrasound. The hip is dislocated and irreducible. What is the most appropriate next step in management?
- A Continue Pavlik harness for 6 weeks
- B Observation with repeat ultrasound at 6 weeks
- C Closed reduction under anesthesia and spica casting ✓
- D Open reduction and pelvic osteotomy
Correct answer: C. Closed reduction under anesthesia and spica casting
Explanation
In an infant under 6 months with a reducible or irreducible hip, closed reduction under arthrogram followed by spica casting is the standard primary treatment when harness fails or the hip is irreducible. The Pavlik harness is contraindicated in irreducible hips as it risks avascular necrosis and femoral nerve palsy. Open reduction is reserved for failed closed reduction.
Reference: Rockwood and Wilkins' Fractures in Children, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.