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Developmental dysplasia of the hip — DCH MCQ

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HardNeonatologyDevelopmental dysplasia of the hipDCH

A female infant is born cephalic at 39 weeks following successful external cephalic version at 37+2 weeks. Her mother was treated with a Pavlik harness during infancy. On newborn examination, leg lengths and hip abduction are symmetrical and the Barlow and Ortolani manoeuvres are negative. A soft left-sided hip click is heard, but there is no palpable clunk. What is the most appropriate investigation?

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Correct answer: B — Hip ultrasound at 4 to 6 weeks

The correct answer is B. This infant has two national NIPE hip risk factors: breech presentation after 36 completed weeks, which remains relevant despite successful external cephalic version and cephalic birth, and a first-degree relative who required treatment for an early-life hip disorder. These risk factors make the newborn hip screen positive even when Barlow and Ortolani manoeuvres are normal. Hip ultrasound should therefore be performed at 4–6 weeks. The soft click is not equivalent to the palpable clunk that defines clinical instability. A neonatal pelvic radiograph is inappropriate because the cartilaginous hip is better assessed by ultrasound. MRI is unnecessary, and imaging should not be delayed until later infancy. Routine examination alone is insufficient because the specified risk factors independently require referral into the ultrasound pathway.

Reference: NHS England. Newborn and infant physical examination (NIPE) screening programme handbook, sections 14.2 and 14.8–14.12. Updated 2025. https://www.gov.uk/government/publications/newborn-and-infant-physical-examination-programme-handbook/newborn-and-infant-physical-examination-screening-programme-handbook