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A - MSRA Paediatrics [15] > [81] Developmental Dysplasia of the Hip > Flashcards

[81] Developmental Dysplasia of the Hip Flashcards

1
Q

What is developmental dysplasia of the hip (DDH)?

A

A problem with the way the hip joint develops

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2
Q

When is DDH present from?

A

Usually present from birth, although it may develop later

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3
Q

When is the outcome for DDH excellent?

A

When diagnosed and treated early in a young baby

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4
Q

What happens if treatment for DDH is delayed?

A

It is more complex, and has less chance of being successful

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5
Q

Describe the head of the femur in a normal hip

A

It is a smooth, rounded ball

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6
Q

Describe the acetabulum in a normal hip

A

It is a smooth, cup-like shape

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7
Q

Where is the abnormality in DDH?

A

Shape of the head of the femur, the shape of the acetabulum, or supporting structures around them

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8
Q

What is the result of abnormalities in the femur, acetabulum, or supporting structures in DDH?

A

The acetabulum and the femur are not in close contact

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9
Q

What is the spectrum of severity of DDH, in terms of the relationship between the acetabulum and the femur?

A

It can be a mild deformity, where there is some contact between them (subluxation), or a severe abnormality where there is no contact (dislocation)

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10
Q

What are the risk factors for DDH?

A
  • Female gender
  • Family history
  • Oligohydraminos
  • First-born child
  • Breech delivery
  • Neuromuscular disorders
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11
Q

Give 2 neuromuscular disorders that increase the risk of DDH?

A
  • Cerebral palsy

- Meningomyelocele

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12
Q

When is screening for DDH done?

A

It is part of the physical examination of the newborn and 6-8 week old babies

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13
Q

Does normal examination in the neonatal period does not preclude a subsequent diagnosis of DDH?

A

No

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14
Q

What are the clinical features of DDH in children under 3 months old?

A
  • Asymmetry

- Positive Ortolani and Barlow test

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15
Q

Where may asymmetry be noted in DDH in under 3 month olds?

A
  • Gluteal or thigh skin folds

- Limb length discrepancy

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16
Q

In what age group should you perform the Ortolani and Barlow tests?

A

Under 3 months

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17
Q

How is the Ortolani test performed?

A

You apply gentle forward pressure to each femoral head in turn

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18
Q

What do the results of the Ortolani test show?

A

Palpable movement suggests the hip is dislocated or subluxed, but reducible

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19
Q

How is the Barlow test performed?

A

You apply gentle backwards pressure to the head of each femur in turn

20
Q

What do the results of the Barlow test suggest?

A

A subluxable hip is suspected on the basis of complete or partial displacement

21
Q

Why are the Ortolani and Barlow tests only done in under 3 month olds?

A

They are useful in neonates, but become difficult by 2-3 months of age

22
Q

What are the clinical features of DDH in 3-6 month olds?

A
  • Unilateral dislocation
  • Asymmetry of hip position
  • Hip may be in fixed position
  • Galeazzi sign
23
Q

When might the hip be in a fixed position in DDH in 3-6 month olds?

A

If the hip is dislocated

24
Q

How is the Galeazzi sign identified?

A

The child is examined supine, with the hips and knees flexed to 90 degrees, and the height of each knee is compared. Unilateral femoral shortening is a positive Galeazzi sign

25
Q

What does a positive Galeazzi sign indicate?

A

May signify hip dislocation

26
Q

What are the clinical features of DDH in older children?

A
  • Limited abduction when fully flexed
  • May walk on toes on affected side
  • Painless limp
27
Q

What investigations are done in DDH?

A
  • Dynamic ultrasound or hip ultrasound
  • Pelvic x-rays
  • CT and MRI scanning may be needed
28
Q

What is the purpose of a dynamic ultrasound in DDH?

A

Assess hip stability and acetabular development in infants

29
Q

When is hip ultrasound useful in DDH?

A

In children under 4.5 months

30
Q

When are pelvic x-rays useful in DDH?

A

Older infants and children, once the femoral head ossification centre has developed

31
Q

What is the limitation of CT and MRI scanning in DDH?

A

Require sedation

32
Q

What happens to most unstable hips by 2-6 weeks of age?

A

They stabilise spontaneously

33
Q

When does DDH require treatment?

A

Any hip that remains dislocatable or pathologically unstable by 2-6 weeks requires prompt treatment

34
Q

What is the first line treatment for DDH in children younger than 6 months?

A

Bracing

35
Q

How is bracing achieved in DDH?

A

With a dynamic flexion-abduction orthrosis, called a Pavlik harness

36
Q

Should the Pavlik harness be left on at all times?

A

Yes

37
Q

What is the purpose of the Pavlik harness?

A

It maintains hip reduction, and can be adjusted as the child grows and the hip stablises

38
Q

What are the main risks of treatment with a Pavlik harness?

A
  • Avascular necrosis

- Temporary femoral nerve palsy

39
Q

When is surgery an option in DDH?

A
  • In children whom non-operative treatment has failed

- In children diagnosed after 6 months of age

40
Q

What is the most common surgical procedure used in DDH?

A

Closed reduction with adductor or psoas tenotomy

41
Q

What must a closed reduction with adductor or psoas tenotomy for DDH be followed by?

A

3-4 months in plaster cast or abduction brace

42
Q

What happens as a child gets older, with regards to management?

A

The older the child, the more likely an extensive procedure will be required

43
Q

What more extensive procedure may be required in an older child with DDH?

A

Open reduction and soft tissue stabilisation of the joint, followed by a cast

44
Q

What complications can result from surgery in DDH?

A
  • Re-dislocation
  • Stiffness
  • Blood loss
  • Avascular necrosis of capital femoral epiphysis
45
Q

Why is DDH an important condition?

A

Because it is a major cause of childhood disability

46
Q

What are the potential long term complications of DDH?

A
  • Premature degenerative joint disease

- Low back pain

A - MSRA Paediatrics [15] (115 decks)

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