Developmental Dysplasia of the Hip Flashcards
Define developmental dysplasia of the hip.
Spectrum of conditions affecting proximal femur + acetabulum, ranging from acetabular immaturity to hip subluxation + frank hip dislocation.
6 RFs for developmental dysplasia of the hip.
F > M
Breech presentation
FH
1st born (smaller uterus)
Oligohydramnios
Birth weight > 5 kg
Summarise the epidemiology of developmental dysplasia of the hip.
1–3 % of newborns
Slightly more common in left hip.
~20% bilateral.
4 signs of developmental dysplasia of the hip?
Limited abduction on affected side
Abnormal gait/ limp: Delayed crawling/ walking, toe walking
Limb-length discrepancy (Galeazzi sign)
Asymmetrical skin folds
What are the investigations for developmental dysplasia of the hip?
USS Hip
XR Hip if >4.5m
What is the management for developmental dysplasia of the hip?
- Most unstable hips spontaneously stabilise by 3-6w
- Pavlik harness splints until 5-6m. USS monitoring.
- Late dx (post 6m) requires preoperative traction then closed reduction with adductor/ psoas tenotomy, then plaster cast/ abduction brace
What are complications associated with developmental dysplasia of the hip?
Tx related Avascular necrosis of femoral head
Osteoarthritis of the hip.
What is the prognosis of developmental dysplasia of the hip?
Pavlik harness effective if < 6m.
Prognosis worsens with age
What is considered true DDH?
Femoral head has persistently abnormal anatomical relationship with pelvic acetabulum
Leads to abnormal bony development
Can result in premature arthritis + significant disability.
What is the key to conservative tx?
Early detection
Late dx associated with hip dysplasia + complex tx
What manoeuvres are used at the newborn and 6 week baby checks?
Barlow: hip flexed to 90 + adducted, whilst hand placed on knee to apply posterior pressure to DISLOCATE posteriorly out of hip
Ortolani: hip flexed to 90 + abducted, with fingers over greater trochanter/ hip, applying anterior pressure to RELOCATE back into acetabulum
