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Developmental Dysplasia of the Hips (DDH) Pathway Paediatrics Department

Developmental Dysplasia of the Hips (DDH) Pathway Paediatrics Department

 

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DDH (Developmental Dysplasia of the Hips) QUICK LINKS

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CLINICAL MANAGEMENT OF DDH
CLINICAL MANAGEMENT OF DDH
DDH Pathway Flowchart
DDH Pathway
Flowchart
Ordering Hip X-rays
Ordering
Hip X-rays
Hip Examination
Hip
Examination
INFORMATION AND HANDOUTS FOR FAMILIES
INFORMATION AND HANDOUTS FOR FAMILIES
WDHB DDH Pamphlet
WDHB
DDH
Pamphlet
Starship Orthopaedics DDH Pamphlet
Starship
Orthopaedics
DDH
Pamphlet
REFERRAL LETTERS
REFERRAL LETTERS
FURTHER READING AND INFORMATION
FURTHER READING AND INFORMATION
DDH Educational videos
DDH
Educational
videos
DDH Guideline, ADHB
DDH
Guideline,
ADHB
I n d e x o f p a g e s Resources and pathway
I n d e x o f p a g e s Resources and pathway
I n d e x o f p a g e s Resources and pathway

Index of pages

I n d e x o f p a g e s Resources and pathway development

Resources and pathway development team

I n d e x o f p a g e s Resources and pathway development
I n d e x o f p a g e s Resources and pathway development

Auditing

I n d e x o f p a g e s Resources and pathway development
I n d e x o f p a g e s Resources and pathway development
Developmental Dysplasia of the Hips (DDH) Pathway Paediatrics Department

Developmental Dysplasia of the Hips (DDH) Pathway Paediatrics Department

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Quick
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DDH MANAGEMENT FLOWCHART

INITIAL NEWBORN ASSESSMENT BY LEAD MATERNITY CARER · Assess for DDH risk factors. How to
INITIAL NEWBORN ASSESSMENT BY LEAD MATERNITY CARER
· Assess for DDH risk factors.
How to
· Initial newborn exam within first 24 hours and
further exam at 1 week.
examine
baby’s hips
· Babies in SCBU will be evaluated by the paediatric
team and managed accordingly.
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HELPFUL HINT!

DDH Risk Factors:

· Breech presentation

· Family history of DDH

· Other congenital anomalies

· Neuromuscular disorders

(First born female has higher risk.)

Outcome of LMC hip assessment Abnormal exam (Hips dislocated/ dislocatable, or uncertain) LMC referral to
Outcome of LMC
hip assessment
Abnormal exam
(Hips dislocated/ dislocatable,
or uncertain)
LMC referral to Paediatrics
to review hips.
“Soft signs”
Outcome of
Normal exam
(Clicky hips, asymmetric
creases, apparent leg length
discrepancy)
paediatric
assessment
(Hips not dislocated or
dislocatable)
Abnormal or
uncertain exam
Are DDH risk factors
present?
Hips dislocated/
dislocatable
Document in baby’s electronic
medical record.
Yes
No
Referral to Paediatric
Orthopaedic Surgery at
Starship Hospital
Normal newborn
Hip X-ray needed
at age 4 months
care.
Click here for more info
Document in baby’s
electronic medical record.
I n d e x o f p a g e s Resources and pathway
I n d e x o f p a g e s Resources and pathway
I n d e x o f p a g e s Resources and pathway

Index of pages

I n d e x o f p a g e s Resources and pathway development

Resources and pathway development team

I n d e x o f p a g e s Resources and pathway development
I n d e x o f p a g e s Resources and pathway development

Auditing

I n d e x o f p a g e s Resources and pathway development
I n d e x o f p a g e s Resources and pathway development
Developmental Dysplasia of the Hips (DDH) Pathway Paediatrics Department
Developmental Dysplasia of the Hips (DDH) Pathway Paediatrics Department

Developmental Dysplasia of the Hips (DDH) Pathway Paediatrics Department

Back to FLOW CHART Click here
Back to
FLOW CHART
Click here
Quick Links Click here
Quick
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ARRANGING HIP X-RAYS FOR A BABY WITH RISK FACTORS FOR DDH

Lead Maternity Carer’s responsibilities · Gives DDH pamphlet to the family. WDHB DDH Pamphlet Starship
Lead Maternity Carer’s responsibilities
· Gives DDH pamphlet to the family.
WDHB DDH Pamphlet
Starship Orthopaedics DDH pamphlet
· Sends referrral letter to GP (and gives copy to the parents)
GP letter
· Completes documentation on baby’s Electronic Medical
Record
General Practitioner’s responsibilities
· Organises and reviews AP pelvis x-ray at 4 months of age
(corrected gestational age). Requests a copy of x-ray to
Paediatric Orthopaedic Surgery department, Starship
Hospital.
· If patient DNA for x-ray, the referring physician will be
notified by radiology department and is responsible for re-
ordering the x-ray.
Outcome of Hip X-ray Normal Normal newborn care.
Outcome of
Hip X-ray
Normal
Normal newborn care.

Abnormal or

inderterminate

result

Referral to Paediatric Orthopaedic Surgery at Starship Hospital.
Referral to Paediatric
Orthopaedic Surgery at
Starship Hospital.
I n d e x o f p a g e s Resources and pathway
I n d e x o f p a g e s Resources and pathway
I n d e x o f p a g e s Resources and pathway

Index of pages

I n d e x o f p a g e s Resources and pathway development

Resources and pathway development team

I n d e x o f p a g e s Resources and pathway development
I n d e x o f p a g e s Resources and pathway development

Auditing

I n d e x o f p a g e s Resources and pathway development
I n d e x o f p a g e s Resources and pathway development
Developmental Dysplasia of the Hips (DDH) Pathway Paediatrics Department

Developmental Dysplasia of the Hips (DDH) Pathway Paediatrics Department

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Quick
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AUDIT CRITERIA

The following criteria will be used to audit the pathway:

1) Percentage of breech babies who have x-rays requested.

2) Who ordered the x-rays (LMC, GP, paediatrician, orthopaedics)

3) Percentage of breech babies with x-rays completed by 6 months

4) Random chart reviews of documentation of hip examination

5) Percentage of abnormal hip x-rays which have been reviewed by Orthopaedics.

6) Percentage of babies with abnormal x-rays which have been referred to Orthopaedic Surgery.

PUBLISHMENT AND REVIEW DATES

This pathway was published on: 26/09/2016

Review dates:

Next review due:

Sept 2017

I n d e x o f p a g e s Resources and pathway
I n d e x o f p a g e s Resources and pathway
I n d e x o f p a g e s Resources and pathway

Index of pages

I n d e x o f p a g e s Resources and pathway development

Resources and pathway development team

I n d e x o f p a g e s Resources and pathway development
I n d e x o f p a g e s Resources and pathway development

Auditing

I n d e x o f p a g e s Resources and pathway development
I n d e x o f p a g e s Resources and pathway development
Developmental Dysplasia of the Hips (DDH) Pathway Paediatrics Department

Developmental Dysplasia of the Hips (DDH) Pathway Paediatrics Department

Quick Links Click here
Quick
Links
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REFERENCES

· Starship Paediatric Orthopaedic Clinical Information, December 2014 http://www.healthpoint.co.nz/public/

paediatrics/starship-paediatric-orthopaedics/?medpro=show&solo=mpTreatmentGuidelinesList&index=3

· ADHB Newborn Services Clinical Guidelines, DDH (2009). http://www.adhb.govt.nz/newborn/Guidelines/ Developmental/DDH.htm

· Congenital muscular torticollis: current concepts and review of treatment. Curr Opin Pediatr 18:26-9, 2006.

· Nemeth BA, Narotam V. Developmental Dysplasia of the Hip. Pediatrics in Review 2012;33;553.

· Sewell, MD, et al. Developmental dysplasia of the hip. BMJ 2009;339:1242-8.

· Storer S, Skaggs D. Development Dysplasia of the Hip. AAFP 2006;74;8 1310-6.Do T,

PATHWAY DEVELOPMENT TEAM

Jutta van dem Boom, paediatrician Todd Warner, paediatrician

I n d e x o f p a g e s Resources and pathway
I n d e x o f p a g e s Resources and pathway
I n d e x o f p a g e s Resources and pathway

Index of pages

I n d e x o f p a g e s Resources and pathway development

Resources and pathway development team

I n d e x o f p a g e s Resources and pathway development
I n d e x o f p a g e s Resources and pathway development

Auditing

I n d e x o f p a g e s Resources and pathway development
I n d e x o f p a g e s Resources and pathway development
Developmental Dysplasia of the Hips (DDH) Pathway Paediatrics Department

Developmental Dysplasia of the Hips (DDH) Pathway Paediatrics Department

Quick Links Click here
Quick
Links
Click here

INDEX OF PATHWAY PAGES

Clinical information

DDH Pathway Flowchart Hip examination WDHB DDH Guideline

Patient handouts

GP communication

Pathway development and auditing

Auditing criteria and dates Resources and pathway development team

I n d e x o f p a g e s Resources and pathway
I n d e x o f p a g e s Resources and pathway
I n d e x o f p a g e s Resources and pathway

Index of pages

I n d e x o f p a g e s Resources and pathway development

Resources and pathway development team

I n d e x o f p a g e s Resources and pathway development
I n d e x o f p a g e s Resources and pathway development

Auditing

I n d e x o f p a g e s Resources and pathway development
I n d e x o f p a g e s Resources and pathway development