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Developmental dysplasia of the hip — MSRA MCQ

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ModerateHip and GroinDevelopmental dysplasia of the hipMSRA

A 7-week-old infant attends for the 6–8-week GP check. The newborn hip examination was documented as normal. On reviewing the maternity record, you note that the fetus was breech at 37 weeks’ gestation, followed by successful external cephalic version; the infant was delivered cephalic at term. The infant moves both legs symmetrically. Leg lengths and knee heights are equal, hip abduction is symmetrical, and Barlow and Ortolani manoeuvres are negative. There is no first-degree family history of developmental dysplasia of the hip. What is the most appropriate next step?

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Correct answer: B — Refer directly for urgent paediatric orthopaedic assessment

Explanation lettering: D = shown as A · C = shown as B · B = shown as C · E = shown as D · A = shown as E

This infant has a national NIPE hip risk factor: breech presentation at or after 36 completed weeks’ gestation, irrespective of presentation at birth or mode of delivery. A successful external cephalic version and cephalic delivery therefore do not remove the risk. The normal examination does not make the screening result negative once this risk factor has been identified. Because the risk factor has been recognised at the 6–8-week infant examination, this is now a screen-positive infant result. The NIPE programme advises direct urgent referral to a paediatric orthopaedic surgeon, with expert review by 10 weeks of age. This differs from the usual newborn screen-positive pathway, in which hip ultrasound is arranged at 4–6 weeks and specialist review occurs by 6 weeks. A is too late and misses the urgent infant-screen pathway. B is initially attractive because ultrasound is appropriate for risk-factor screening identified at birth, but at this age the specified pathway is direct specialist referral rather than GP-led imaging and result management. D and E incorrectly treat a normal Barlow/Ortolani examination as sufficient reassurance despite a qualifying breech history.

Reference: Newborn and infant physical examination (NIPE) screening programme handbook (Updated 10 October 2025) — https://www.gov.uk/government/publications/newborn-and-infant-physical-examination-programme-handbook/newborn-and-infant-physical-examination-screening-programme-handbook Newborn and infant physical examination (NIPE) screening programme handbook (Updated 10 October 2025) — https://www.gov.uk/government/publications/newborn-and-infant-physical-examination-programme-handbook/newborn-and-infant-physical-examination-screening-programme-handbook