A 4-month-old female infant is found to have a dislocatable left hip on clinical screening. Ultrasound confirms a reducible hip with an alpha angle of 52°. Which is the most appropriate initial management?

• A Closed reduction and hip spica casting under anesthesia
• B Pavlik harness ✓
• C Open reduction with pelvic osteotomy
• D Observation with repeat ultrasound at 12 months

Explanation

In infants younger than 6 months with reducible developmental dysplasia of the hip, the Pavlik harness is the first-line treatment. It maintains the hip in approximately 100 to 110 degrees of flexion and moderate abduction, facilitating spontaneous concentric reduction and acetabular remodeling. Beyond 6 months of age, closed reduction with arthrogram and spica casting is preferred, as the harness is less effective in older infants with established soft tissue contractures.

Reference: Rockwood and Green's Fractures in Children, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.