Disorders of the Hip and Lower Extremity

Published on 06/06/2015 by admin

Filed under Pediatrics

Last modified 06/06/2015

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23 Disorders of the Hip and Lower Extremity

The pediatrician’s knowledge of orthopedic disorders must be broad because the clinical presentation and diagnostic approach vary widely with age. Although many of the disorders discussed here are managed in conjunction with orthopedic surgeons, they can often be diagnosed by history and physical examination alone, and some do not require surgical intervention. In addition, delayed diagnosis of relatively common disorders such as developmental hip dysplasia remains one of the largest causes of litigation against primary care pediatricians, and more importantly, results in preventable long-term disability. Furthermore, mismanagement of disorders of rapidly changing bones may lead to chronic morbidity.

We divide several common disorders of the hips and lower extremities into one of three categories: congenital, developmental, or acquired.


A vast array of genetic diseases may present with lower limb anomalies at birth. In utero teratogen exposure can also lead to limb deformities. For instance, thalidomide has been off the market in the United States for many years secondary to its association with severe limb deformities. Illicit drugs or alcohol can also cause limb foreshortening. Amniotic bands can also cause structural changes, leading to amputation or dysplasia of limbs.


In utero packaging causes some expected changes in every infant; some of these variations may take 3 to 4 years to resolve. Some of the more common disorders associated with packaging include rotational problems of the lower extremities such as in-toeing and out-toeing, which are often noted when a child begins to walk.


In-toeing is expected in children until the lower limbs laterally rotate with time; adult walking patterns are not observed until about 7 or 8 years of age. The cause of in-toeing varies by age, often caused by metatarsus adductus in infants, internal tibial torsion in toddlers, and excessive femoral anteversion in preschool-aged children.


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