DEVELOPMENTAL DYSPLASIA OF HIP / CONG. DISLOCATION OF HIP

Question 1

DEFINE

Answer 1

SPONTANEOUS PARTIAL OR COMPLETE DISPLACEMENT OF FEMORAL HEAD FROM ACETABULAR CAVITY OCCURING BEFORE , DURING OR SHORTLY AFTER BIRTH .

Question 2

SEX

Answer 2

FEMALE

Question 3

IF UNILATERAL

Answer 3

LEFT

Question 4

RISK FACTORS

Answer 4

FIRST BORN
FEMALE
FAMILIAL HISTORY
FOOT PRESENTATION
FLUID DEFICIENCY ( OLIGOHYDRAMINOS)
CAUCASIANS
CO MORBIDITIES LIKE TORTICOLLIS, CTEV

Question 5

CLINICAL FEATURES

Answer 5

NEONATE
INFANT
OLDER CHILDREN

Question 6

NEONATE

Answer 6

LIMITED HIP MOVEMENT
CLICK DURING HIP MOVEMENT
TESTS =
BARLOW ( DONE WITHIN 2 TO 3 DAYS )
ORTOLANI ( DONE BETWEEN 3 TO 9 MONTHS )
TEST FOR HIP ABDUCTION

Question 7

BARLOW TEST 1ST PART

Answer 7

1ST PART =
SURGEON GRASPS THE UPPER PART OF EACH THIGH , WITH FINGERS ON GREATER TROCHANTER AND THUMB IN FRONT.
CHILD KNEES FULLY FLEXED, HIP FLEXED TO RIGHT ANGLE .
HIP GENTLY ADDUCTED , GENTLE PRESSURE ON PROXIMAL DIRECTION, WITH THUMB TRIES TO PUSH OUT HIP .
IF HIP JOINT DISLOCATABLE , FEMORAL HEAD ROLLS OUT THE POSTERIOR LIP OF ACETABULUM WITH CLUNK SOUND .
IF NOTHING HAPPENS , EITHER NORMAL OR AREADY DISLOCATED .

Question 8

BARLOW TEST 2ND PART

Answer 8

HIPS IN 90 DEGREE FLEXION
FULLY ADDUCTED
THIGHS GETLY ABDUCTED , TRY TO PULL HIPS IN FORWARD DIRECTION WITH FINGERS ON GREATER TROCHANTER
IF HIP WAS DISLOCATED CLUNK HEARD AND HIP REDUCED
IF NOTHING HAPPENS , NORMAL OR IRREDUCABLE DISLOCATION .

Question 9

ORTOLANI TEST

Answer 9

NORMALLY THERE IS SMOOTH ABDUCTION TILL KNEE TOUCHES THE COUCH .
BUT IF ABDUCTION STOPS HALFWWAY AND NO SIGNS OF JERK OF ENTRY THEN IRREDUCABLE HIP .

Question 10

INFANTS

Answer 10

ASSYMETRICAL FOLDS
WIDENED PERINEUM
-ORTOLANI TEST POSITIVE
-BARLOWS TEST POSITIVE
-ALLIS SIGN POSITIVE

Question 11

OLDER CHILDREN

Answer 11

1.UNILATERAL DDH =
ASYMMETRICAL FOLDS
SHORT LEG
TRENDELENBURG GAIT
2.BILATERAL DDH =
PERINEUM WIDENED
SAILORS GAIT
LORDOSIS
DECREASED ABDUCTION AND EXTERNAL ROTATION
COMPENSATORY GENU VALGUM

+TESTS TO BE PERFORMED =
TRENDELENBURG TEST POSITIVE
TELESCOPY POSITIVE
VASCULAR SIGN OF NARATH POSITIVE

Question 12

IMAGING

Answer 12

USG - USEFUL IN EARLY DIAGNOSIS AT BIRTH
X RAY
MRI

Question 13

X RAY

Answer 13

SHENTONS LINE DISRUPTED
DELAYED APPEARANCE OF OSSIFICATION CENTRE OF FEMORAL HEAD
SLOPING ACETABULUM
VON ROSEN LINE DISRUPTED

Question 14

TREATMENT

Answer 14

0 TO 6 MONTHS
6 TO 18 MONTHS
18 MONTHS TO 4 YEARS
4 TO 10 YEARS
MORE THAN 11 YEARS

Question 15

0 TO 6 MONTHS

Answer 15

IF DISLOCATED = ABDUCTION SPLINTAGE ( PAVLIK HARNESS SPLINT / VON ROSENS SPLINT )
IF DISLOCATABLE = OBSERVE FOR 3 WEEKS , AND IF UNSTABLE THEN APLLY ABDUCTION SPLINTAGE IN REDUCED POSITION UNTIL X RAY SHOWS GOOD ACETABULAR ROOF .
PAVLIK HARNESS USED ONLY IN LESS THAN 6 MONTHS

Question 16

6 MONTHS TO 18 MONTHS

Answer 16

CLOSED REDUCTION UNDER GA
SPLINTAGE ( 90 DEGREE FLEXION, 40 DEGREE ABDUCTION AND 20 DEGREE INTERNAL ROTATION ) WITH PLASTER SPICA FOR 6 WEEKS

Question 17

18 MONTHS TO 4 YEAR

Answer 17

OPEN REDUCTION WITH FEMORAL SHORTENING AND ACETABULAR RECONSTRUCTION ( SALTERS OSTEOTOMY , CHIARIS PELVIC DISPLACEMENT OSTEOTOMY , PEMBERTON PERICAPSULAR OSTEOTOMY )

Question 18

4 TO 10 YEARS

Answer 18

UNILATERAL =
OPEN REDUCTION WITH FEMORAL SHORTENING , DEROTATION OSTEOTOMY AND ACETABULAR RECONSTRUCTION .
BILATERAL =
NON INTERVATION UNTIL SEVERE PAIN AND DEFORMITY

Question 19

MORE THAN 11 YEARS

Answer 19

IF ONLY ONE HIP , TOTAL HIP REPLACEMENT ONCE ADULTHOOD REACHED .
SOMETIMES ARTHRODESIS OF HIP REQUIRED