Guideline discordance in the management of a toddler with Developmental Dysplasia of the Hip

Background: Guidelines are used in clinical practice to provide clear direction and supporting evidence for a range of conditions pertinent to that practitioner. In Developmental Dysplasia of the Hip (DDH), several guidelines exist detailing management. Case report: This case chronicles a 13-month-old toddler who demonstrated indications of hip dysplasia. Ultrasound at 31 days of age revealed physiologically immature hips. A recommendation for observation was initiated at this point. At 14 weeks of age, ultrasound revealed an 11-degree alpha angle variance (72° right, 61° left) and a recommendation to review with a general medical practitioner at nine months of age. At nine months of age, x-ray imaging revealed a right acetabular angle of 24°, a left acetabular angle of 34.5°, and a clear disruption to Shenton’s line signifying left acetabular dysplasia. Several guidelines are available, yet errors in management are still occurring, which may reflect a lack of clarity and action within these guidelines regarding clinical intervention. Without regular assessment, dysplastic changes were not detected until nine months of age. Conclusion: Results of examination and screening ultrasound should undergo careful interpretation, with significant asymmetry interpreted as abnormal development and treated appropriately to avoid long-term disability. Emphasis must be on early detection for appropriate management.