Asymmetry of gluteal folds of skin is a sign of?

HPSSC - 2015

Child Health Nursing (Pediatrics)

Easy

Appeared in: HPSSC - 2015

Explanation

Asymmetry of the gluteal and thigh skin folds is a classic sign of Developmental Dysplasia of the Hip (DDH).
This occurs because the femoral head is displaced from the acetabulum, causing the leg on the affected side to be relatively shorter, which results in uneven skin creases.
The image provided clearly demonstrates this asymmetry, with the left gluteal fold being higher than the right.
Other signs in an infant (older than 2-3 months) include limited hip abduction and a positive Galeazzi sign (unequal knee heights).

Option A: A femur fracture is an acute traumatic injury. It would present with immediate and severe pain, swelling, deformity, and inability to bear weight, not with subtle, pre-existing skin fold asymmetry.
Option B: Osteomyelitis is a bone infection. It presents with systemic signs of infection like fever and irritability, along with localized signs of inflammation such as warmth, redness, swelling, and point tenderness over the bone.
Option C: A hip fracture in an infant is extremely rare and would be caused by significant trauma. Similar to a femur fracture, it would cause acute pain, swelling, and refusal to move the leg.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical signs of Developmental Dysplasia of the Hip (DDH) in infants as background academic context rather than a clinical decision trigger.
Nurses play a crucial role in screening for DDH during routine well-baby check-ups by performing physical assessments, including checking for symmetrical gluteal folds, equal leg lengths, and performing the Ortolani and Barlow maneuvers.
Early detection and treatment (e.g., with a Pavlik harness) are critical to prevent long-term complications like a limp, chronic pain, and early-onset arthritis.
Patient education is vital. Nurses must teach parents how to care for a child in a Pavlik harness, including skin care, diapering, and signs of complications like impaired circulation.

How to Approach the Question

First, analyze the image provided. Observe the key finding, which is the clear asymmetry of the skin folds on the infant's buttocks and thighs.
Next, read the question stem: "Asymmetry of gluteal folds of skin is a sign of?". This asks you to connect the visual sign to a specific medical condition.
Evaluate each option based on your clinical knowledge and the visual evidence.
Option A (Femur fracture), B (Osteomyelitis), and C (Hip fracture) are acute conditions presenting with pain, swelling, and/or signs of infection. These do not match the chronic, subtle sign of asymmetrical folds.
Option D (Hip Displacement/DDH) is a developmental condition where asymmetrical skin folds are a well-known clinical indicator in infants.
Therefore, conclude that the sign shown in the image and described in the question is characteristic of DDH.

Concept Tested & Keywords

Concept Tested: Clinical signs of Developmental Dysplasia of the Hip (DDH) in infants.
Stem keywords: Asymmetry, gluteal folds, skin
Lead-in keywords: sign of
Clinical cues: The finding of asymmetrical skin folds is a key screening indicator for a developmental issue in an infant, not an acute injury or infection.

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