A 5-year-old boy presents with a waddling gait and bilateral lower limb shortening. Trendelenburg test is positive bilaterally. Pelvis radiograph shows bilateral hip dislocations with delayed ossification of femoral heads. Which condition is most likely?

• A Bilateral Legg-Calvé-Perthes disease
• B Multiple epiphyseal dysplasia
• C Bilateral slipped capital femoral epiphysis
• D Bilateral developmental dysplasia of the hip ✓

Explanation

Bilateral hip dislocations with delayed ossification and a waddling gait in a 5-year-old are classic for neglected bilateral DDH. Perthes disease shows increased density and fragmentation of the femoral head but not dislocation at this age. SCFE presents in older children (10-16 years) with displacement through the physis. Multiple epiphyseal dysplasia shows irregular epiphyseal ossification bilaterally but no dislocation.

Reference: Tachdjian's Pediatric Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.